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General NPI Number Information
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NPI Number | 1962548974
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Entity Type | Organization
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Legal Business Name | NORTHEAST MISSOURI HEALTH COUNCIL INC
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Dates
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Enumeration Date | 01/29/2007
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Last Update Date | 06/24/2011
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Provider Practice Location Address
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Address Line | 1506 CROWN DRIVE
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City | KIRKSVILLE
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State | MO
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Zip | 63501
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Country | US
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Telephone | 660-627-4493
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Fax | 660-627-4288
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Provider Business Mailing Address
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Address Line | 1416 CROWN DRIVE
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City | KIRKSVILLE
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State | MO
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Zip | 63501-2548
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Country | US
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Telephone | 660-627-5757
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Fax | 660-627-5802
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Authorized Official
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Title or Position | EXECUTIVE DIRECTOR
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Name | ANDREW H GRIMM
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Credential |
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Telephone | 660-627-5757
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 002241
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License Number State | MO
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Taxonomy #2
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 2006005622
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License Number State | MO
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Taxonomy #3
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 2005037424
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License Number State | MO
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Taxonomy #4
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | R5E64
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License Number State | MO
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Taxonomy #5
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | R5N07
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License Number State | MO
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Taxonomy #6
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 111208
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License Number State | MO
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Taxonomy #7
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | 096968
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License Number State | MO
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Taxonomy #8
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Taxonomy Code | 261QF0400X
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Taxonomy Name | Federally Qualified Health Center (FQHC)
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License Number |
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License Number State | MO
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