Provider Demographics
NPI:1306932108
Name:PULASKI COUNTY HEALTH DEPARTMENT
Entity type:Organization
Organization Name:PULASKI COUNTY HEALTH DEPARTMENT
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:DEBORAH
Authorized Official - Middle Name:
Authorized Official - Last Name:DECKER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:573-774-3820
Mailing Address - Street 1:PO BOX 473
Mailing Address - Street 2:
Mailing Address - City:WAYNESVILLE
Mailing Address - State:MO
Mailing Address - Zip Code:65583-0473
Mailing Address - Country:US
Mailing Address - Phone:573-774-3820
Mailing Address - Fax:573-774-3375
Practice Address - Street 1:104 ASHLEY MAY ST
Practice Address - Street 2:
Practice Address - City:WAYNESVILLE
Practice Address - State:MO
Practice Address - Zip Code:65583-3440
Practice Address - Country:US
Practice Address - Phone:737-743-8205
Practice Address - Fax:573-774-3375
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-05
Last Update Date:2025-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251K00000XAgenciesPublic Health or Welfare
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO511130908Medicaid