Healthcare Provider Details

I. General information

NPI: 1417469537
Provider Name (Legal Business Name): KNOX COUNTY HEALTH DEPARTMENT
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/30/2017
Last Update Date: 07/22/2020
Certification Date: 07/22/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

102 W MONTICELLO ST
EDINA MO
63537-1150
US

IV. Provider business mailing address

102 W MONTICELLO ST
EDINA MO
63537-1150
US

V. Phone/Fax

Practice location:
  • Phone: 660-397-3396
  • Fax: 660-397-3579
Mailing address:
  • Phone: 660-397-3396
  • Fax: 660-397-3579

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code251K00000X
TaxonomyPublic Health or Welfare Agency
License Number
License Number StateMO
# 2
Primary TaxonomyY
Taxonomy Code261QP0905X
TaxonomyState or Local Public Health Clinic/Center
License Number
License Number StateMO

VIII. Authorized Official

Name: LORI R MOOTS-CLAIR
Title or Position: ADMINISTRATOR
Credential:
Phone: 660-397-3396