Provider Demographics
NPI:1164432738
Name:BENTON CO PUBLIC HEALTH
Entity type:Organization
Organization Name:BENTON CO PUBLIC HEALTH
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:BARRY
Authorized Official - Middle Name:RAY
Authorized Official - Last Name:PABST
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:660-438-2876
Mailing Address - Street 1:PO BOX 935
Mailing Address - Street 2:
Mailing Address - City:WARSAW
Mailing Address - State:MO
Mailing Address - Zip Code:65355-0935
Mailing Address - Country:US
Mailing Address - Phone:660-438-2876
Mailing Address - Fax:660-438-5746
Practice Address - Street 1:1238 COMMERCIAL ST
Practice Address - Street 2:
Practice Address - City:WARSAW
Practice Address - State:MO
Practice Address - Zip Code:65355-3157
Practice Address - Country:US
Practice Address - Phone:660-438-2876
Practice Address - Fax:660-438-5746
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:BENTON CO PUBLIC HEALTH
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-08-08
Last Update Date:2024-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251G00000XAgenciesHospice Care, Community Based
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO822062105Medicaid
MO822062105Medicaid