Provider Demographics
NPI:1386718682
Name:CALDWELL COUNTY HEALTH DEPARTMENT
Entity type:Organization
Organization Name:CALDWELL COUNTY HEALTH DEPARTMENT
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:SHELLY
Authorized Official - Middle Name:
Authorized Official - Last Name:SIMS
Authorized Official - Suffix:
Authorized Official - Credentials:RN BSN
Authorized Official - Phone:816-586-2311
Mailing Address - Street 1:275 SOUTH WASHINGTON STREET
Mailing Address - Street 2:PO BOX 66
Mailing Address - City:KINGSTON
Mailing Address - State:MO
Mailing Address - Zip Code:64650-0066
Mailing Address - Country:US
Mailing Address - Phone:816-586-2311
Mailing Address - Fax:816-586-2603
Practice Address - Street 1:275 SOUTH WASHINGTON STREET
Practice Address - Street 2:
Practice Address - City:KINGSTON
Practice Address - State:MO
Practice Address - Zip Code:64650-0066
Practice Address - Country:US
Practice Address - Phone:816-586-2311
Practice Address - Fax:816-586-2603
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-20
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251K00000XAgenciesPublic Health or Welfare
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO9003920Medicare ID - Type Unspecified