Healthcare Provider Details

I. General information

NPI: 1477821684
Provider Name (Legal Business Name): KENNETT HMA LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/02/2011
Last Update Date: 03/09/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1231 1ST ST SUITE 5
KENNETT MO
63857-2527
US

IV. Provider business mailing address

1301 1ST ST
KENNETT MO
63857-2525
US

V. Phone/Fax

Practice location:
  • Phone: 573-888-8690
  • Fax: 573-517-1085
Mailing address:
  • Phone: 573-888-4522
  • Fax: 573-888-5525

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: PAULA M LALOR
Title or Position: DIRECTOR/DELEGATED OFFICIAL
Credential:
Phone: 615-925-4565