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General NPI Number Information
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NPI Number | 1174522882
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Entity Type | Organization
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Legal Business Name | ELK RIVER HEALTH SERVICES, INC.
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Dates
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Enumeration Date | 07/15/2005
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Last Update Date | 04/15/2014
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Provider Practice Location Address
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Address Line | 109 N BROADWAY ST
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City | SOUTH WEST CITY
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State | MO
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Zip | 64863-9417
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Country | US
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Telephone | 417-762-3287
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Fax | 417-762-3255
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Provider Business Mailing Address
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Address Line | PO BOX 160 109 N BROADWAY
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City | SOUTH WEST CITY
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State | MO
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Zip | 64863-0160
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Country | US
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Telephone | 417-762-3287
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Fax | 417-762-3255
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Authorized Official
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Title or Position | DIRECTOR OF CLINICS
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Name | VICKI PLUMLEE
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Credential |
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Telephone | 417-762-3287
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QR1300X
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Taxonomy Name | Rural Health Clinic/Center
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License Number |
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License Number State | OK
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Taxonomy #2
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Taxonomy Code | 261QR1300X
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Taxonomy Name | Rural Health Clinic/Center
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License Number |
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License Number State | MO
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