Healthcare Provider Details

I. General information

NPI: 1538167333
Provider Name (Legal Business Name): JMH DIVISIFIED HEALTHCARE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/14/2005
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1400 HIGHWAY 61
FESTUS MO
63028-4100
US

IV. Provider business mailing address

PO BOX 279
FESTUS MO
63028-0279
US

V. Phone/Fax

Practice location:
  • Phone: 636-933-5730
  • Fax: 636-933-5301
Mailing address:
  • Phone: 636-933-5730
  • Fax: 636-933-5301

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3416L0300X
TaxonomyLand Ambulance
License Number099121
License Number StateMO

VIII. Authorized Official

Name: MR. DENNIS PATRICK HALLEY
Title or Position: ADMINISTRATOR
Credential: MSA
Phone: 636-933-1178