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NPI Code Detail

MEDICARE: ADVOCATES FOR A HEALTHY COMMUNITY, INC.

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
1261QF0400XFederally Qualified Health Center (FQHC)

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
126D1013631OTHERMOCLIA
2MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1588773477
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 : 417-851-1551
Fax Number : 417-831-0155
Provider Business Practice Location Address
First Line : 323 E GRAND ST
Second Line :
City : SPRINGFIELD
State : MO
Zip : 65807-1447
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 : 12/02/2021

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