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General NPI Number Information
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NPI Number | 1295058287
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Entity Type | Organization
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Legal Business Name | SALT RIVER COMMUNITY HEALTH CENTER
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Dates
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Enumeration Date | 03/05/2010
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Last Update Date | 05/01/2011
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Provider Practice Location Address
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Address Line | 248 N MORGAN ST
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City | KAHOKA
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State | MO
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Zip | 63445-1433
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Country | US
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Telephone | 660-727-1500
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Fax | 660-727-1502
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Provider Business Mailing Address
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Address Line | 3145 N HIGHWAY 61
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City | HANNIBAL
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State | MO
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Zip | 63401-6588
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Country | US
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Telephone | 573-221-4422
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Fax | 537-221-4403
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Authorized Official
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Title or Position | EXECUTIVE DIRECTOR
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Name | JOAN F HYNEK
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Credential |
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Telephone | 573-221-4422
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM1300X
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Taxonomy Name | Multi-Specialty Clinic/Center
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License Number | 19782870
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License Number State | MO
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