Healthcare Provider Details

I. General information

NPI: 1154784460
Provider Name (Legal Business Name): HEALTH CARE COALITION OF LAFAYETTE COUNTY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/04/2016
Last Update Date: 04/11/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1411A N JEFFERSON ST
CARROLLTON MO
64633-1945
US

IV. Provider business mailing address

825 S BUSINESS HIGHWAY 13
LEXINGTON MO
64067-1515
US

V. Phone/Fax

Practice location:
  • Phone: 660-259-0224
  • Fax:
Mailing address:
  • Phone: 660-259-2400
  • Fax: 660-251-0524

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number
License Number State

VIII. Authorized Official

Name: TONIANN RICHARD
Title or Position: EXECUTIVE DIRECTOR
Credential:
Phone: 660-256-2440