Healthcare Provider Details

I. General information

NPI: 1598968489
Provider Name (Legal Business Name): RICHLAND MEDICAL CENTER, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/07/2007
Last Update Date: 04/08/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

304 W WASHINGTON AVE
RICHLAND MO
65556-7101
US

IV. Provider business mailing address

PO BOX 777
RICHLAND MO
65556-0777
US

V. Phone/Fax

Practice location:
  • Phone: 573-765-5131
  • Fax: 573-765-3122
Mailing address:
  • Phone: 573-765-5131
  • Fax: 573-765-3122

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number
License Number StateMO
# 2
Primary TaxonomyN
Taxonomy Code261QF0400X
TaxonomyFederally Qualified Health Center (FQHC)
License Number
License Number State

VIII. Authorized Official

Name: PAUL P BOCCI
Title or Position: CFO
Credential:
Phone: 314-422-3617