Provider Demographics
NPI:1871574210
Name:KNOX COUNTY HEALTH DEPARTMENT
Entity type:Organization
Organization Name:KNOX COUNTY HEALTH DEPARTMENT
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:LORI
Authorized Official - Middle Name:R
Authorized Official - Last Name:MOOTS-CLAIR
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:660-397-3396
Mailing Address - Street 1:102 W MONTICELLO ST
Mailing Address - Street 2:
Mailing Address - City:EDINA
Mailing Address - State:MO
Mailing Address - Zip Code:63537-1150
Mailing Address - Country:US
Mailing Address - Phone:660-397-3396
Mailing Address - Fax:660-397-3579
Practice Address - Street 1:102 W MONTICELLO ST
Practice Address - Street 2:
Practice Address - City:EDINA
Practice Address - State:MO
Practice Address - Zip Code:63537-1150
Practice Address - Country:US
Practice Address - Phone:660-397-3396
Practice Address - Fax:660-397-3579
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-11-11
Last Update Date:2021-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO148-31HH251E00000X
MO251K00000X, 261QP0905X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
No251K00000XAgenciesPublic Health or Welfare
No261QP0905XAmbulatory Health Care FacilitiesClinic/CenterPublic Health, State or Local
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO581942505Medicaid
MO267125Medicare ID - Type UnspecifiedPROVIDER NUMBER