Healthcare Provider Details

I. General information

NPI: 1275721110
Provider Name (Legal Business Name): HEALTH CONNECTION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/04/2007
Last Update Date: 10/04/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1507 E BROADWAY HILLCREST HALL
COLUMBIA MO
65215-0001
US

IV. Provider business mailing address

PO BOX 7687
COLUMBIA MO
65205-7687
US

V. Phone/Fax

Practice location:
  • Phone: 573-882-1718
  • Fax:
Mailing address:
  • Phone: 573-882-3757
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code172V00000X
TaxonomyCommunity Health Worker
License Number
License Number State

VIII. Authorized Official

Name: RICHARD OLIVER
Title or Position: DEAN
Credential:
Phone: 573-882-8425