Healthcare Provider Details

I. General information

NPI: 1659366417
Provider Name (Legal Business Name): LINCOLN COUNTY HEALTH DEPARTMENT
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/16/2005
Last Update Date: 10/11/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5 HEALTH DEPARTMENT DR
TROY MO
63379-4551
US

IV. Provider business mailing address

5 HEALTH DEPARTMENT DR
TROY MO
63379-4551
US

V. Phone/Fax

Practice location:
  • Phone: 636-528-6117
  • Fax: 636-528-8629
Mailing address:
  • Phone: 636-528-6117
  • Fax: 636-528-8629

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WC1500X
TaxonomyCommunity Health Registered Nurse
License Number053723
License Number StateMO

VIII. Authorized Official

Name: MR. BRETT SIEFERT
Title or Position: ADMINISTRATOR
Credential:
Phone: 636-528-6117