Provider Demographics
NPI:1104965169
Name:LAWRENCE COUNTY HEALTH DEPARTMENT
Entity type:Organization
Organization Name:LAWRENCE COUNTY HEALTH DEPARTMENT
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:RN, ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:JANELLA
Authorized Official - Middle Name:
Authorized Official - Last Name:SPENCER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:417-466-2201
Mailing Address - Street 1:105 W NORTH ST
Mailing Address - Street 2:
Mailing Address - City:MOUNT VERNON
Mailing Address - State:MO
Mailing Address - Zip Code:65712-1017
Mailing Address - Country:US
Mailing Address - Phone:417-466-2201
Mailing Address - Fax:417-466-7485
Practice Address - Street 1:105 W NORTH ST
Practice Address - Street 2:
Practice Address - City:MOUNT VERNON
Practice Address - State:MO
Practice Address - Zip Code:65712-1017
Practice Address - Country:US
Practice Address - Phone:417-466-2201
Practice Address - Fax:417-466-7485
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-06
Last Update Date:2022-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251K00000XAgenciesPublic Health or Welfare
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO511878704Medicaid