Healthcare Provider Details

I. General information

NPI: 1053430561
Provider Name (Legal Business Name): MERCER COUNTY HEALTH DEPARTMENT
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/28/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

305 W MAIN ST
PRINCETON MO
64673-1133
US

IV. Provider business mailing address

305 W MAIN ST
PRINCETON MO
64673-1133
US

V. Phone/Fax

Practice location:
  • Phone: 660-748-3630
  • Fax: 660-748-3634
Mailing address:
  • Phone: 660-748-3630
  • Fax: 660-748-3634

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: PHYLLIS JANE JOHNSON
Title or Position: ADMINISTRATOR
Credential:
Phone: 660-748-3630