Healthcare Provider Details

I. General information

NPI: 1942294046
Provider Name (Legal Business Name): PERRY COUNTY HEALTH SYSTEM
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/02/2005
Last Update Date: 04/13/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2 CIRCLE DR
PERRYVILLE MO
63775-1248
US

IV. Provider business mailing address

434 N WEST ST
PERRYVILLE MO
63775-1359
US

V. Phone/Fax

Practice location:
  • Phone: 573-547-7133
  • Fax: 573-517-0347
Mailing address:
  • Phone: 573-547-7133
  • Fax: 573-517-0347

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number651-7
License Number StateMO

VIII. Authorized Official

Name: MR. RANDY WOLF
Title or Position: VICE PRESIDENT OF FINANCE
Credential:
Phone: 573-547-2530