MEDICARE: STODDARD COUNTY HEALTH CENTER

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	:	1619957313
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	STODDARD COUNTY HEALTH CENTER

Provider Business Mailing Address
First Line	:	PO BOX 277
Second Line	:	1001 HWY 25 N
City	:	BLOOMFIELD
State	:	MO
Zip	:	63825-0277
Country	:	US
Telephone Number	:	573-568-4593
Fax Number	:	573-568-4736

Provider Business Practice Location Address
First Line	:	1001 HWY 25 N
Second Line	:
City	:	BLOOMFIELD
State	:	MO
Zip	:	63825-0277
Country	:	US
Telephone Number	:	573-568-4593
Fax Number	:	573-568-4736

Authorized Official
Title or Position	:	OFFICE ASSISTANT
Name	:	MRS. RHONDA JEAN SHEPARD
Credential	:
Telephone Number	:	573-568-4593

Provider Enumeration Date	:	01/19/2006
Last Update Date	:	08/22/2020

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Directions to “STODDARD COUNTY HEALTH CENTER ” Practice Location

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