Healthcare Provider Details

I. General information

NPI: 1912658840
Provider Name (Legal Business Name): COUNTY OF CEDAR MISSOURI
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/12/2022
Last Update Date: 07/10/2025
Certification Date: 07/10/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1317 SOUTH HWY 32 SUITE B
EL DORADO SPRINGS MO
64744-0161
US

IV. Provider business mailing address

1317 SOUTH HWY 32 SUITE B
EL DORADO SPRINGS MO
64744-0161
US

V. Phone/Fax

Practice location:
  • Phone: 417-876-5477
  • Fax: 417-876-5017
Mailing address:
  • Phone: 417-876-5477
  • Fax: 417-876-5017

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251K00000X
TaxonomyPublic Health or Welfare Agency
License Number
License Number State

VIII. Authorized Official

Name: MR. DON BOULTINGHOUSE
Title or Position: NORTHERN COMMISSIONER
Credential:
Phone: 417-276-6700