Healthcare Provider Details

I. General information

NPI: 1972584340
Provider Name (Legal Business Name): AUDRAIN COUNTY HEALTH CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/10/2005
Last Update Date: 12/05/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1130 S ELMWOOD
MEXICO MO
65265-0957
US

IV. Provider business mailing address

1130 S ELMWOOD P.O. BOX 957
MEXICO MO
65265-0957
US

V. Phone/Fax

Practice location:
  • Phone: 573-581-6060
  • Fax: 573-581-6652
Mailing address:
  • Phone: 573-581-6060
  • Fax: 573-581-6652

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251G00000X
TaxonomyCommunity Based Hospice Care Agency
License Number
License Number State

VIII. Authorized Official

Name: DR. PATRICIA BURKE
Title or Position: BOARD CHAIRPERSON
Credential: M. D.
Phone: 573-581-1332