Healthcare Provider Details

I. General information

NPI: 1720075161
Provider Name (Legal Business Name): BURTON CREEK RURAL CLINIC, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/30/2005
Last Update Date: 02/05/2026
Certification Date: 02/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

805 KENTUCKY AVE
WEST PLAINS MO
65775
US

IV. Provider business mailing address

805 N KENTUCKY AVE
WEST PLAINS MO
65775-2022
US

V. Phone/Fax

Practice location:
  • Phone: 417-256-2111
  • Fax: 417-256-4858
Mailing address:
  • Phone: 417-256-2111
  • Fax: 417-256-4858

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QR1300X
TaxonomyRural Health Clinic/Center
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number StateNULL

VIII. Authorized Official

Name: MR. THERESA CHRISTINE GREGG
Title or Position: ADMINISTRATOR
Credential: MHA
Phone: 417-256-2111