Healthcare Provider Details

I. General information

NPI: 1902892375
Provider Name (Legal Business Name): MONTGOMERY COUNTY HEALTH DEPARTMENT
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/21/2005
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

400 SALISBURY ST
MONTGOMERY CITY MO
63361-1232
US

IV. Provider business mailing address

400 SALISBURY ST
MONTGOMERY CITY MO
63361-1232
US

V. Phone/Fax

Practice location:
  • Phone: 573-564-2495
  • Fax: 573-564-5059
Mailing address:
  • Phone: 573-564-2495
  • Fax: 573-564-5059

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number25917
License Number StateMO
# 2
Primary TaxonomyN
Taxonomy Code251K00000X
TaxonomyPublic Health or Welfare Agency
License Number
License Number StateMO

VIII. Authorized Official

Name: LINDA HARMAN
Title or Position: ADMINISTRATOR
Credential:
Phone: 573-564-2495