Healthcare Provider Details

I. General information

NPI: 1053509356
Provider Name (Legal Business Name): BROOKFIELD FAMILY HEALTH CLINIC PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/11/2007
Last Update Date: 06/13/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

624 W. LOCKLING ST
BROOKFIELD MO
64628-2336
US

IV. Provider business mailing address

624 W LOCKLING ST
BROOKFIELD MO
64628-2003
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 Number
License Number State

VIII. Authorized Official

Name: TAMMY J SUMMERS
Title or Position: OFFICE MNANAGER
Credential:
Phone: 660-258-3363