Healthcare Provider Details

I. General information

NPI: 1346301504
Provider Name (Legal Business Name): DEXTER HOSPTIAL LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/12/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1707 N DOULGAS
MALDEN MO
63863
US

IV. Provider business mailing address

PO BOX 368
DEXTER MO
63841
US

V. Phone/Fax

Practice location:
  • Phone: 573-276-6488
  • Fax:
Mailing address:
  • Phone: 573-624-3165
  • Fax: 573-624-3157

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: SUE ANN WILLIAMS
Title or Position: CLINIC ADMINISTRATOR
Credential:
Phone: 573-624-1640