Healthcare Provider Details

I. General information

NPI: 1619957313
Provider Name (Legal Business Name): STODDARD COUNTY HEALTH CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/19/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1001 HWY 25 N
BLOOMFIELD MO
63825-0277
US

IV. Provider business mailing address

PO BOX 277 1001 HWY 25 N
BLOOMFIELD MO
63825-0277
US

V. Phone/Fax

Practice location:
  • Phone: 573-568-4593
  • Fax: 573-568-4736
Mailing address:
  • Phone: 573-568-4593
  • Fax: 573-568-4736

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251K00000X
TaxonomyPublic Health or Welfare Agency
License Number
License Number State

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name: MRS. RHONDA JEAN SHEPARD
Title or Position: OFFICE ASSISTANT
Credential:
Phone: 573-568-4593