MEDICARE: BOTHWELL REGIONAL 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
1	261QR1300X	Rural Health Clinic/Center

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	37038013	OTHER	MO	BLUE CROSS BLUE SHIELD
2	CK7172	OTHER	MO	PALMETTO GBA
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1902854037
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BOTHWELL REGIONAL HEALTH CENTER

Provider Business Mailing Address
First Line	:	PO BOX 801128
Second Line	:
City	:	KANSAS CITY
State	:	MO
Zip	:	64180-1128
Country	:	US
Telephone Number	:	660-827-0015
Fax Number	:	660-827-7425

Provider Business Practice Location Address
First Line	:	3700 W 10TH ST STE 100
Second Line	:
City	:	SEDALIA
State	:	MO
Zip	:	65301-2540
Country	:	US
Telephone Number	:	660-827-0015
Fax Number	:	660-827-7425

Authorized Official
Title or Position	:	CHIEF FINANCIAL OFFICER
Name	:	STEVEN R DAVIS
Credential	:	CFO
Telephone Number	:	660-829-7790

Provider Enumeration Date	:	05/04/2006
Last Update Date	:	02/17/2023

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Directions to “BOTHWELL REGIONAL HEALTH CENTER ” Practice Location

Language	Start Address	Practice Location

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