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NPI Code Detail

MEDICARE: SOUTH CENTRAL MISSOURI COMMUNITY HEALTH CENTER

MEDICARE: SOUTH CENTRAL MISSOURI COMMUNITY HEALTH CENTER
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1261QF0400XFederally Qualified Health Center (FQHC)

General Provider Information

NPI Number : 1083298640
Entity Type Code : Organization
Provider Name (Legal Business Name) : SOUTH CENTRAL MISSOURI COMMUNITY HEALTH CENTER
Provider Business Mailing Address
First Line : 1081 E 18TH ST
Second Line :
City : ROLLA
State : MO
Zip : 65401-2448
Country : US
Telephone Number : 573-426-2407
Fax Number : 573-426-6723
Provider Business Practice Location Address
First Line : 155 PARK DR
Second Line :
City : SAINT ROBERT
State : MO
Zip : 65584-7860
Country : US
Telephone Number : 573-426-2407
Fax Number :
Authorized Official
Title or Position : HR/CREDENTIALING SPECIALIST
Name : ELIZABETH SPARKS
Credential :
Telephone Number : 573-426-2407
Provider Enumeration Date : 05/10/2021
Last Update Date : 11/19/2021

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Directions to “SOUTH CENTRAL MISSOURI COMMUNITY HEALTH CENTER ” Practice Location

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