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	:	1407490741
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ADVOCATES FOR A HEALTHY COMMUNITY INC

Provider Business Mailing Address
First Line	:	440 E TAMPA ST
Second Line	:
City	:	SPRINGFIELD
State	:	MO
Zip	:	65806-1131
Country	:	US
Telephone Number	:	417-831-0150
Fax Number	:

Provider Business Practice Location Address
First Line	:	2238 W KINGSLEY ST
Second Line	:
City	:	SPRINGFIELD
State	:	MO
Zip	:	65807-5456
Country	:	US
Telephone Number	:	417-831-0150
Fax Number	:

Authorized Official
Title or Position	:	DIRECTOR OF FINANCE
Name	:	JO ANNE THOMPSON
Credential	:	CPA
Telephone Number	:	417-851-1551

Provider Enumeration Date	:	10/30/2019
Last Update Date	:	12/02/2021

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