MEDICARE: BETTY JEAN KERR PEOPLE'S HEALTH CENTERS

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)

Other Identifiers

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

General Provider Information

NPI Number	:	1639207590
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BETTY JEAN KERR PEOPLE'S HEALTH CENTERS

Provider Business Mailing Address
First Line	:	7200 MANCHESTER RD
Second Line	:
City	:	MAPLEWOOD
State	:	MO
Zip	:	63143-2403
Country	:	US
Telephone Number	:	314-781-9162
Fax Number	:	314-781-2034

Provider Business Practice Location Address
First Line	:	7200 MANCHESTER RD
Second Line	:
City	:	MAPLEWOOD
State	:	MO
Zip	:	63143-2403
Country	:	US
Telephone Number	:	314-781-9162
Fax Number	:	314-781-2034

Authorized Official
Title or Position	:	PRESIDENT & CEO
Name	:	DWAYNE BUTLER
Credential	:
Telephone Number	:	314-367-7848

Provider Enumeration Date	:	03/01/2007
Last Update Date	:	05/13/2014

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