Healthcare Provider Details

I. General information

NPI: 1851420525
Provider Name (Legal Business Name): ELK RIVER HEALTH SERVICES, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/05/2007
Last Update Date: 04/16/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5265 S BUS HWY 71 SUITE J
PINEVILLE MO
64856-0265
US

IV. Provider business mailing address

PO BOX 265
PINEVILLE MO
64856-0265
US

V. Phone/Fax

Practice location:
  • Phone: 417-223-4290
  • Fax: 417-223-4299
Mailing address:
  • Phone: 417-223-4290
  • Fax: 417-223-4299

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: VICKI PLUMLEE
Title or Position: DIRECTOR OF CLINICS
Credential:
Phone: 417-223-4290