MEDICARE: ADVOCATES FOR A HEALTHY COMMUNITY, INC.

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
1	261QF0400X	Federally Qualified Health Center (FQHC)

General Provider Information

NPI Number	:	1275642282
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ADVOCATES FOR A HEALTHY COMMUNITY, INC.

Provider Business Mailing Address
First Line	:	PO BOX 5681
Second Line	:
City	:	SPRINGFIELD
State	:	MO
Zip	:	65801-5681
Country	:	US
Telephone Number	:	417-831-0150
Fax Number	:	417-831-0155

Provider Business Practice Location Address
First Line	:	630 W KEARNEY ST
Second Line	:
City	:	SPRINGFIELD
State	:	MO
Zip	:	65803-2508
Country	:	US
Telephone Number	:	417-831-0150
Fax Number	:	417-831-0155

Authorized Official
Title or Position	:	EXECUTIVE DIRECTOR
Name	:	MR. KENNETH BROOKS MILLER JR.
Credential	:
Telephone Number	:	417-831-0150

Provider Enumeration Date	:	08/30/2006
Last Update Date	:	08/22/2020

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