Basic Information
| Provider Information | |||||||||
| NPI: | 1609113224 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | MONTGOMERY COUNTY HEALTH DEPARTMENT | ||||||||
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| Mailing Information | |||||||||
| Address1: | 330 PAGEANT LN | ||||||||
| Address2: | |||||||||
| City: | CLARKSVILLE | ||||||||
| State: | TN | ||||||||
| PostalCode: | 370403854 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9316485747 | ||||||||
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| Practice Location | |||||||||
| Address1: | 330 PAGEANT LN | ||||||||
| Address2: | |||||||||
| City: | CLARKSVILLE | ||||||||
| State: | TN | ||||||||
| PostalCode: | 370403854 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9316485747 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 01/16/2013 | ||||||||
| LastUpdateDate: | 01/16/2013 | ||||||||
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| AuthorizedOfficialLastName: | COWAN | ||||||||
| AuthorizedOfficialFirstName: | PAULETTE | ||||||||
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| AuthorizedOfficialTitleorPosition: | HUMAN RESOURCES | ||||||||
| AuthorizedOfficialTelephone: | 6156507024 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 261QC1500X | 0000115065 | TN | Y | Ambulatory Health Care Facilities | Clinic/Center | Community Health |
No ID Information.