Healthcare Provider Details

I. General information

NPI: 1285952044
Provider Name (Legal Business Name): DYERSBURG CLINIC CORP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/04/2010
Last Update Date: 05/14/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

310 E MAIN ST
HAYTI MO
63851-1639
US

IV. Provider business mailing address

PO BOX 848392
BOSTON MA
02284-8392
US

V. Phone/Fax

Practice location:
  • Phone: 573-359-2517
  • Fax: 573-359-6281
Mailing address:
  • Phone: 617-402-1000
  • Fax: 617-402-1099

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: DEBBIE BREWER
Title or Position: DIRECTOR
Credential:
Phone: 615-465-7626