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General NPI Number Information
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NPI Number | 1871508622
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Entity Type | Organization
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Legal Business Name | COUNTY BOARD OF TRUSTEES
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Dates
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Enumeration Date | 07/30/2006
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Last Update Date | 01/24/2011
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Provider Practice Location Address
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Address Line | 2323 GREEN ST
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City | CENTERVILLE
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State | MO
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Zip | 63633
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Country | US
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Telephone | 573-648-2498
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Fax | 573-648-2510
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Provider Business Mailing Address
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Address Line | 2323 GREEN ST P O BOX 40
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City | CENTERVILLE
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State | MO
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Zip | 63633
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Country | US
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Telephone | 573-648-2498
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Fax | 573-648-2510
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Authorized Official
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Title or Position | ADMINISTRATOR
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Name | KATHLEEN ZIMMERMAN
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Credential | RN
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Telephone | 573-648-2498
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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 |
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License Number State |
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