Healthcare Provider Details

I. General information

NPI: 1902763386
Provider Name (Legal Business Name): SOUTH CENTRAL MISSOURI COMMUNITY HEALTH CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/07/2026
Last Update Date: 01/07/2026
Certification Date: 01/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

703 S GRAND AVE
SALEM MO
65560
US

IV. Provider business mailing address

703 S GRAND AVE
SALEM MO
65560
US

V. Phone/Fax

Practice location:
  • Phone: 573-426-4455
  • Fax:
Mailing address:
  • Phone: 573-426-4455
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code333600000X
TaxonomyPharmacy
License Number
License Number State

VIII. Authorized Official

Name: MICHELLE SEIBERT
Title or Position: CREDENTIALING SPECIALIST
Credential:
Phone: 573-426-4455