Healthcare Provider Details

I. General information

NPI: 1124220637
Provider Name (Legal Business Name): MINERAL AREA OSTEOPATHIC HOSPITAL INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/05/2007
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1103 WEBER RD SUITE 102
FARMINGTON MO
63640-3326
US

IV. Provider business mailing address

603 WALLACE ROAD
FARMINGTON MO
63640
US

V. Phone/Fax

Practice location:
  • Phone: 573-756-3662
  • Fax: 573-756-3640
Mailing address:
  • Phone: 573-756-3662
  • Fax: 573-756-3640

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number
License Number StateMO
# 2
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number StateMO
# 3
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number StateMO

VIII. Authorized Official

Name: RICK JENKINS
Title or Position: ACFO
Credential:
Phone: 573-701-7293