Provider Demographics
NPI:1902892375
Name:MONTGOMERY COUNTY HEALTH DEPARTMENT
Entity Type:Organization
Organization Name:MONTGOMERY COUNTY HEALTH DEPARTMENT
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:LINDA
Authorized Official - Middle Name:
Authorized Official - Last Name:HARMAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:573-564-2495
Mailing Address - Street 1:400 SALISBURY ST
Mailing Address - Street 2:
Mailing Address - City:MONTGOMERY CITY
Mailing Address - State:MO
Mailing Address - Zip Code:63361-1232
Mailing Address - Country:US
Mailing Address - Phone:573-564-2495
Mailing Address - Fax:573-564-5059
Practice Address - Street 1:400 SALISBURY ST
Practice Address - Street 2:
Practice Address - City:MONTGOMERY CITY
Practice Address - State:MO
Practice Address - Zip Code:63361-1232
Practice Address - Country:US
Practice Address - Phone:573-564-2495
Practice Address - Fax:573-564-5059
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-09-21
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO25917251E00000X
MO251K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
No251K00000XAgenciesPublic Health or Welfare
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO511670002Medicaid
MO581670007Medicaid
MO8475OtherHCUSA
MO=========MONOtherMERCY HOME HEALTH
MO8475OtherHCUSA
MO=========CLIOtherMERCY MC+