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General NPI Number Information
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NPI Number | 1023210648
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Entity Type | Organization
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Legal Business Name | MISSISSIPPI COUNTY HEALTH DEPARTMENT
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Dates
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Enumeration Date | 06/05/2007
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Last Update Date | 12/07/2023
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Provider Practice Location Address
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Address Line | 1200 E MARSHALL ST
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City | CHARLESTON
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State | MO
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Zip | 63834-1336
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Country | US
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Telephone | 573-683-2191
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Fax | 573-683-6539
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Provider Business Mailing Address
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Address Line | 1200 E MARSHALL ST
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City | CHARLESTON
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State | MO
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Zip | 63834-1336
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Country | US
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Telephone | 573-683-2191
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Fax | 573-683-6539
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Authorized Official
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Title or Position | ADMINISTRATOR
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Name | RACHELLE JOHNSON
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Credential | RD, LD, CDE
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Telephone | 573-683-2191
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251K00000X
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Taxonomy Name | Public Health or Welfare Agency
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License Number | 126551
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License Number State | MO
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Taxonomy #2
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Taxonomy Code | 251K00000X
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Taxonomy Name | Public Health or Welfare Agency
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License Number | 33173
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License Number State | MO
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