Healthcare Provider Details

I. General information

NPI: 1235359449
Provider Name (Legal Business Name): COUNTY OF CRAWFORD
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/27/2007
Last Update Date: 07/16/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

518 PINE ST
STEELVILLE MO
65565-6041
US

IV. Provider business mailing address

PO BOX 367 202 W MAIN ST
STEELVILLE MO
65565-0367
US

V. Phone/Fax

Practice location:
  • Phone: 573-775-5838
  • Fax:
Mailing address:
  • Phone: 573-775-2555
  • Fax: 573-775-3826

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251K00000X
TaxonomyPublic Health or Welfare Agency
License Number105130
License Number StateMO

VIII. Authorized Official

Name: MS. SHIRLEY JEAN STULCE
Title or Position: ADMINISTRATOR
Credential:
Phone: 573-775-2555