MEDICARE: MONTGOMERY COUNTY HEALTH DEPARTMENT

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	251K00000X	Public Health or Welfare Agency

General Provider Information

NPI Number	:	1215440417
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MONTGOMERY COUNTY HEALTH DEPARTMENT

Provider Business Mailing Address
First Line	:	400 SALISBURY ST
Second Line	:
City	:	MONTGOMERY CITY
State	:	MO
Zip	:	63361-1232
Country	:	US
Telephone Number	:	573-564-2495
Fax Number	:	573-564-5059

Provider Business Practice Location Address
First Line	:	400 SALISBURY ST
Second Line	:
City	:	MONTGOMERY CITY
State	:	MO
Zip	:	63361-1232
Country	:	US
Telephone Number	:	573-564-2495
Fax Number	:	573-564-5059

Authorized Official
Title or Position	:	ADMINISTRATOR
Name	:	LINDA HARMANN
Credential	:	N/A
Telephone Number	:	573-564-2495

Provider Enumeration Date	:	11/09/2017
Last Update Date	:	11/09/2017

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