Provider Demographics
NPI:1306937396
Name:LIVINGSTON COUNTY PUBLIC HEALTH CENTER
Entity type:Organization
Organization Name:LIVINGSTON COUNTY PUBLIC HEALTH CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:ELIZABETH
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:MOSS
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:660-646-5506
Mailing Address - Street 1:PO BOX 973
Mailing Address - Street 2:
Mailing Address - City:CHILLICOTHE
Mailing Address - State:MO
Mailing Address - Zip Code:64601-0973
Mailing Address - Country:US
Mailing Address - Phone:660-646-5506
Mailing Address - Fax:660-646-4485
Practice Address - Street 1:800 ADAM DR
Practice Address - Street 2:
Practice Address - City:CHILLICOTHE
Practice Address - State:MO
Practice Address - Zip Code:64601-3900
Practice Address - Country:US
Practice Address - Phone:660-646-5506
Practice Address - Fax:660-646-4485
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-27
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO251K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251K00000XAgenciesPublic Health or Welfare
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO9004033Medicare ID - Type Unspecified