Healthcare Provider Details

I. General information

NPI: 1477862936
Provider Name (Legal Business Name): CITIZENS FOR HEALTH AND WELLNESS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/01/2010
Last Update Date: 10/01/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

102 N FISHER ST
VERSAILLES MO
65084-1202
US

IV. Provider business mailing address

102 N FISHER ST
VERSAILLES MO
65084-1202
US

V. Phone/Fax

Practice location:
  • Phone: 573-378-2349
  • Fax: 573-378-2350
Mailing address:
  • Phone: 573-378-2349
  • Fax: 573-378-2350

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number2004001441
License Number StateMO

VIII. Authorized Official

Name: STEVE YODER
Title or Position: PRESIDENT, BOARD OF DIRECTORS
Credential:
Phone: 573-378-2349