MEDICARE: JMH DIVISIFIED HEALTHCARE

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	3416L0300X	Land Ambulance	099121	MO

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	81 81285	OTHER	MO	MEDICARE COMPLETE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	122373	OTHER	MO	BLUE CHOICE
3	1033804	OTHER	MO	CARE PARTNERS
4	8229	OTHER	MO	HEALTH CARE USA
5	122373	OTHER	MO	BLUE CROSS BLUE SHIELD
6	241762	OTHER	MO	HEALTHLINK
7	3329921	OTHER	MO	HEALTH MARKET

General Provider Information

NPI Number	:	1538167333
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	JMH DIVISIFIED HEALTHCARE

Provider Business Mailing Address
First Line	:	PO BOX 279
Second Line	:
City	:	FESTUS
State	:	MO
Zip	:	63028-0279
Country	:	US
Telephone Number	:	636-933-5730
Fax Number	:	636-933-5301

Provider Business Practice Location Address
First Line	:	1400 HIGHWAY 61
Second Line	:
City	:	FESTUS
State	:	MO
Zip	:	63028-4100
Country	:	US
Telephone Number	:	636-933-5730
Fax Number	:	636-933-5301

Authorized Official
Title or Position	:	ADMINISTRATOR
Name	:	MR. DENNIS PATRICK HALLEY
Credential	:	MSA
Telephone Number	:	636-933-1178

Provider Enumeration Date	:	07/14/2005
Last Update Date	:	08/22/2020

Similar Medicare Providers

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Practice Location Address:

1400 US HIGHWAY 61
FESTUS, MO
63028-4100

Practice Phone: 636-933-1000
Practice Fax:

1417362708 — RITU KATHURIA M.D.
Practice Location Address:

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63028-4100

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1982603650 — DR. BENJAMIN YUHICO ALBANO M.D.
Practice Location Address:

1400 US HIGHWAY 61
FESTUS, MO
63028-4100

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Practice Fax: 636-933-8090

1548269954 — DR. BRADFORD B. KESLER O.D.
Practice Location Address:

1400 US HIGHWAY 61 , SUITE 130
FESTUS, MO
63028-4100

Practice Phone: 636-937-8855
Practice Fax: 636-937-3751

1700878147 — WILLIAM KENNEN JR. DO
Practice Location Address:

1400 HIGHWAY 61 , MOC SOUTH, SUITE 210
FESTUS, MO
63028-4100

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1508859661 — MERCY HOSPITAL JEFFERSON
Practice Location Address:

1400 HIGHWAY 61
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63028-4100

Practice Phone: 636-933-1000
Practice Fax: 636-933-1819

Directions to “JMH DIVISIFIED HEALTHCARE ” Practice Location

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