Healthcare Provider Details

I. General information

NPI: 1841668688
Provider Name (Legal Business Name): BETTY JEAN KERR PEOPLE'S HEALTH CENTERS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/10/2015
Last Update Date: 07/05/2022
Certification Date: 07/05/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5647 DELMAR BLVD.
ST. LOUIS MO
63112-2617
US

IV. Provider business mailing address

5701 DELMAR BLVD.
ST. LOUIS MO
63112-2617
US

V. Phone/Fax

Practice location:
  • Phone: 314-535-7701
  • Fax: 314-535-0385
Mailing address:
  • Phone: 314-367-7848
  • Fax: 314-367-2985

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QF0400X
TaxonomyFederally Qualified Health Center (FQHC)
License NumberN00015533
License Number StateMO

VIII. Authorized Official

Name: MR. MARK SANFORD
Title or Position: EXECUTIVE VICE PRESIDENT
Credential:
Phone: 314-367-7848