=====================================================
General NPI Number Information
=====================================================
NPI Number | 1699411595
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | SOCIAL WELFARE BOARD OF THE COUNTY OF BUCHANAN
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/12/2022
-----------------------------------------------------
Last Update Date | 05/31/2022
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 904 S 10TH ST STE A
-----------------------------------------------------
City | SAINT JOSEPH
-----------------------------------------------------
State | MO
-----------------------------------------------------
Zip | 64503-2400
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 816-233-5189
-----------------------------------------------------
Fax | 816-344-5247
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 904 S 10TH ST STE A
-----------------------------------------------------
City | SAINT JOSEPH
-----------------------------------------------------
State | MO
-----------------------------------------------------
Zip | 64503-2400
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 816-233-5189
-----------------------------------------------------
Fax | 816-344-5247
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | EXECUTIVE DIRECTOR
-----------------------------------------------------
Name | LINDA CARMEL JUDAH
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 816-344-5201
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 261QD0000X
-----------------------------------------------------
Taxonomy Name | Dental Clinic/Center
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------