Healthcare Provider Details

I. General information

NPI: 1427366566
Provider Name (Legal Business Name): REGIONAL HEALTH CARE CLINIC, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/23/2010
Last Update Date: 02/21/2024
Certification Date: 02/21/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

821 WESTWOOD DR
SEDALIA MO
65301-2102
US

IV. Provider business mailing address

821 WESTWOOD DR
SEDALIA MO
65301-2102
US

V. Phone/Fax

Practice location:
  • Phone: 660-826-4774
  • Fax: 660-826-1300
Mailing address:
  • Phone: 660-826-4774
  • Fax: 660-826-1300

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QF0400X
TaxonomyFederally Qualified Health Center (FQHC)
License Number
License Number State

VIII. Authorized Official

Name: MS. MICHAEL WALLER
Title or Position: CEO
Credential:
Phone: 660-826-4774