Healthcare Provider Details

I. General information

NPI: 1447200746
Provider Name (Legal Business Name): MADISON COUNTY HEALTH DEPARTMENT
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/10/2006
Last Update Date: 10/19/2021
Certification Date: 10/19/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

105 ARMORY ST
FREDERICKTOWN MO
63645-1341
US

IV. Provider business mailing address

105 ARMORY ST
FREDERICKTOWN MO
63645-1341
US

V. Phone/Fax

Practice location:
  • Phone: 573-783-2747
  • Fax: 573-783-8039
Mailing address:
  • Phone: 573-783-2747
  • Fax: 573-783-8039

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: ALICA K WHITE
Title or Position: BILLING SUPERVISOR
Credential:
Phone: 573-783-2747