Healthcare Provider Details

I. General information

NPI: 1366626475
Provider Name (Legal Business Name): VELMA DOWDY RCF II
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/26/2007
Last Update Date: 12/26/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

HIGHWAY 60
FREMONT MO
63941-0278
US

IV. Provider business mailing address

PO BOX 278
FREMONT MO
63941-0278
US

V. Phone/Fax

Practice location:
  • Phone: 573-251-3555
  • Fax: 573-251-2589
Mailing address:
  • Phone: 573-251-3555
  • Fax: 573-251-2589

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number309-9694
License Number StateMO
# 2
Primary TaxonomyY
Taxonomy Code261QG0250X
TaxonomyGenetics Clinic/Center
License Number032109
License Number StateMO

VIII. Authorized Official

Name: MS. VELMA R DOWDY
Title or Position: OWNER/OPERATOR
Credential: LPN
Phone: 573-251-3555