Healthcare Provider Details

I. General information

NPI: 1154303204
Provider Name (Legal Business Name): HAYTI MEDICAL CLINIC, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/15/2005
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

223 S 3RD ST
HAYTI MO
63851-1617
US

IV. Provider business mailing address

223 S 3RD ST PO BOX 37
HAYTI MO
63851-1617
US

V. Phone/Fax

Practice location:
  • Phone: 573-359-2930
  • Fax: 573-359-1304
Mailing address:
  • Phone: 573-359-2930
  • Fax: 573-359-1304

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QR1300X
TaxonomyRural Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: GLENN HAYNES
Title or Position: CEO
Credential:
Phone: 573-359-2930