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General NPI Number Information
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NPI Number | 1194797787
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Entity Type | Organization
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Legal Business Name | BETTY JEAN KERR PEOPLE'S HEALTH CENTERS
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Dates
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Enumeration Date | 02/07/2006
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Last Update Date | 05/13/2014
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Provider Practice Location Address
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Address Line | 5701 DELMAR BLVD
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City | SAINT LOUIS
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State | MO
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Zip | 63112-2617
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Country | US
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Telephone | 314-367-7848
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Fax | 314-367-2985
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Provider Business Mailing Address
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Address Line | 5701 DELMAR BLVD
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City | SAINT LOUIS
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State | MO
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Zip | 63112-2617
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Country | US
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Telephone | 314-367-7848
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Fax | 314-367-2985
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Authorized Official
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Title or Position | PRESIDENT & CEO
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Name | DWAYNE BUTLER
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Credential |
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Telephone | 314-367-7848
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QF0400X
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Taxonomy Name | Federally Qualified Health Center (FQHC)
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License Number | 072100
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License Number State | MO
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