Organization Name: | DOUGLAS COUNTY PUBLIC HEALTH SERVICES GROUP, INC. |
NPI Number: | 1871797597 |
Entity Type Code: | Organizational (2) |
Authorized Official Name: | JENNIFER HEINLEIN (HRO) |
Mailing Address: | 504 Nw 10th Ave Ava |
State: | MO US |
Postal Code: | 65608 |
Phone Number: | 4176834831 |
Fax Number: | 4176831602 |
NPI Enumeration Date: | 06/14/2007 |
NPI Last Update Date: | 07/13/2007 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 261QF0400X |
License Number: | 2007014535 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | MO |
Taxonomy Type: | Ambulatory Health Care Facilities |
Taxonomy Classification: | Clinic/Center |
Taxonomy Specialization: | Federally Qualified Health Center (FQHC) |
Taxonomy Definition: |