Provider Demographics
NPI:1427051069
Name:PHELPS COUNTY CLERK
Entity type:Organization
Organization Name:PHELPS COUNTY CLERK
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:JOSEPHINE
Authorized Official - Middle Name:P
Authorized Official - Last Name:WALTMAN
Authorized Official - Suffix:
Authorized Official - Credentials:MS, MED, CPNP
Authorized Official - Phone:573-458-6010
Mailing Address - Street 1:200 N MAIN ST
Mailing Address - Street 2:STE G51
Mailing Address - City:ROLLA
Mailing Address - State:MO
Mailing Address - Zip Code:65401-3070
Mailing Address - Country:US
Mailing Address - Phone:573-458-6010
Mailing Address - Fax:573-458-6060
Practice Address - Street 1:200 N MAIN ST
Practice Address - Street 2:STE G51
Practice Address - City:ROLLA
Practice Address - State:MO
Practice Address - Zip Code:65401-3070
Practice Address - Country:US
Practice Address - Phone:573-458-6010
Practice Address - Fax:573-458-6060
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-05-27
Last Update Date:2007-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MON/A261QP0905X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP0905XAmbulatory Health Care FacilitiesClinic/CenterPublic Health, State or Local