Healthcare Provider Details

I. General information

NPI: 1285901397
Provider Name (Legal Business Name): BROOKFIELD FAMILY HEALTH CLINIC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/18/2011
Last Update Date: 11/18/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

624 WEST LOCKLING
BROOKFIELD MO
64628-2336
US

IV. Provider business mailing address

624 WEST LOCKLING
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 Code261QR1300X
TaxonomyRural Health Clinic/Center
License NumberR9F17
License Number StateMO

VIII. Authorized Official

Name: DR. BRIAN KEVIN KNOWLES
Title or Position: PHYSICIAN/OWNER
Credential: D.O.
Phone: 660-258-3363