Healthcare Provider Details

I. General information

NPI: 1003089699
Provider Name (Legal Business Name): BROOKFIELD FAMILY HEALTH CLINIC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/04/2008
Last Update Date: 04/04/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

125 E LOCKLING ST
BROOKFIELD MO
64628-2336
US

IV. Provider business mailing address

125 E LOCKLING ST
BROOKFIELD MO
64628-2336
US

V. Phone/Fax

Practice location:
  • Phone: 660-258-3363
  • Fax: 660-258-5409
Mailing address:
  • Phone: 660-258-3363
  • Fax: 660-258-5409

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License NumberR9F17
License Number StateMO

VIII. Authorized Official

Name: TAMMY JO SUMMERS
Title or Position: OFFICE MANAGER
Credential:
Phone: 660-258-3363