Healthcare Provider Details

I. General information

NPI: 1558859066
Provider Name (Legal Business Name): SIKESTON HEALTH CARE FOR ALL LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/30/2018
Last Update Date: 04/30/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

808 E WAKEFIELD AVE STE B
SIKESTON MO
63801-5100
US

IV. Provider business mailing address

808 E WAKEFIELD AVE STE B
SIKESTON MO
63801-5100
US

V. Phone/Fax

Practice location:
  • Phone: 573-475-7071
  • Fax:
Mailing address:
  • Phone: 573-475-7071
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code261QR1300X
TaxonomyRural Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MR. NOVA CRAWFORD
Title or Position: OWNER
Credential:
Phone: 573-475-7071