Healthcare Provider Details

I. General information

NPI: 1104106103
Provider Name (Legal Business Name): I AM HEALTH CLINIC, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/22/2011
Last Update Date: 08/22/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1005 S ALLISON RD SUITE A
EL DORADO SPRINGS MO
64744-2431
US

IV. Provider business mailing address

1005 S ALLISON RD SUITE A
EL DORADO SPRINGS MO
64744-2431
US

V. Phone/Fax

Practice location:
  • Phone: 417-876-4771
  • Fax: 417-876-4775
Mailing address:
  • Phone: 417-876-4771
  • Fax: 417-876-4775

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QP2300X
TaxonomyPrimary Care Clinic/Center
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code261QU0200X
TaxonomyUrgent Care Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MRS. CHERI K ALLISON
Title or Position: OWNER/MANAGER
Credential: FNP
Phone: 417-876-4771