Healthcare Provider Details

I. General information

NPI: 1639207590
Provider Name (Legal Business Name): BETTY JEAN KERR PEOPLE'S HEALTH CENTERS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/01/2007
Last Update Date: 05/13/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7200 MANCHESTER RD
MAPLEWOOD MO
63143-2403
US

IV. Provider business mailing address

7200 MANCHESTER RD
MAPLEWOOD MO
63143-2403
US

V. Phone/Fax

Practice location:
  • Phone: 314-781-9162
  • Fax: 314-781-2034
Mailing address:
  • Phone: 314-781-9162
  • Fax: 314-781-2034

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QF0400X
TaxonomyFederally Qualified Health Center (FQHC)
License Number
License Number State

VIII. Authorized Official

Name: DWAYNE BUTLER
Title or Position: PRESIDENT & CEO
Credential:
Phone: 314-367-7848