Healthcare Provider Details

I. General information

NPI: 1578608808
Provider Name (Legal Business Name): BETTY JEAN KERR PEOPLE'S HEALTH CENTERS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/21/2007
Last Update Date: 04/23/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5701 DELMAR BLVD
SAINT LOUIS MO
63112-2617
US

IV. Provider business mailing address

5701 DELMAR BLVD
SAINT LOUIS MO
63112-2617
US

V. Phone/Fax

Practice location:
  • Phone: 314-367-7848
  • Fax: 314-367-4849
Mailing address:
  • Phone: 314-367-7848
  • Fax: 314-367-4849

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336C0002X
TaxonomyClinic Pharmacy
License Number005971
License Number StateMO

VIII. Authorized Official

Name: MARK SANFORD
Title or Position: EVP
Credential:
Phone: 314-367-7848