Healthcare Provider Details

I. General information

NPI: 1013948868
Provider Name (Legal Business Name): BATES COUNTY MEDICAL CLINIC INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/06/2006
Last Update Date: 05/19/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

706 S HIGH ST
BUTLER MO
64730-1833
US

IV. Provider business mailing address

PO BOX 390
BUTLER MO
64730-0390
US

V. Phone/Fax

Practice location:
  • Phone: 660-679-3118
  • Fax: 660-679-6328
Mailing address:
  • Phone: 660-679-3118
  • Fax: 660-679-6328

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QR1300X
TaxonomyRural Health Clinic/Center
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number StateNULL

VIII. Authorized Official

Name: DR. WILLIAM W HAYNIE
Title or Position: PRESIDENT
Credential: M.D.
Phone: 660-679-3118