Healthcare Provider Details

I. General information

NPI: 1619993052
Provider Name (Legal Business Name): STEELE FAMILY RURAL HEALTH CLINIC, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/15/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

216 W MAIN ST
STEELE MO
63877-1436
US

IV. Provider business mailing address

216 W MAIN ST
STEELE MO
63877-1436
US

V. Phone/Fax

Practice location:
  • Phone: 573-695-2181
  • Fax:
Mailing address:
  • Phone: 573-695-2181
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberR9E31
License Number StateMO

VIII. Authorized Official

Name: TIMOTHY WILLIAM MCPHERSON
Title or Position: PHYSICIAN
Credential: DO
Phone: 573-695-2181