Healthcare Provider Details

I. General information

NPI: 1528198157
Provider Name (Legal Business Name): SHANNON COUNTY HEALTH CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/06/2007
Last Update Date: 09/19/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

18018 GREY JONES DRIVE
EMINENCE MO
65466
US

IV. Provider business mailing address

PO BOX 788
EMINENCE MO
65466-0788
US

V. Phone/Fax

Practice location:
  • Phone: 573-226-3914
  • Fax: 573-226-3240
Mailing address:
  • Phone: 573-226-3914
  • Fax: 573-226-3240

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251K00000X
TaxonomyPublic Health or Welfare Agency
License Number
License Number State

VIII. Authorized Official

Name: KANDRA COUNTS
Title or Position: ADMINISTRATOR
Credential:
Phone: 573-226-3914