Provider Demographics
NPI:1912658840
Name:COUNTY OF CEDAR
Entity type:Organization
Organization Name:COUNTY OF CEDAR
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:NORTHERN COMMISSIONER
Authorized Official - Prefix:MR
Authorized Official - First Name:DON
Authorized Official - Middle Name:
Authorized Official - Last Name:BOULTINGHOUSE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:417-276-6700
Mailing Address - Street 1:1317 SOUTH HWY 32
Mailing Address - Street 2:SUITE B
Mailing Address - City:EL DORADO SPRINGS
Mailing Address - State:MO
Mailing Address - Zip Code:64744-0161
Mailing Address - Country:US
Mailing Address - Phone:417-876-5477
Mailing Address - Fax:417-876-5017
Practice Address - Street 1:1317 SOUTH HWY 32
Practice Address - Street 2:SUITE B
Practice Address - City:EL DORADO SPRINGS
Practice Address - State:MO
Practice Address - Zip Code:64744-0161
Practice Address - Country:US
Practice Address - Phone:417-876-5477
Practice Address - Fax:417-876-5017
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:COUNTY OF CEDAR
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2022-01-12
Last Update Date:2022-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251K00000XAgenciesPublic Health or Welfare