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109 E 5th St Caruthersville MO 63830-1417 | |
| (573) 359-9803 | |
| (573) 359-0990 |
| Full Name | |
|---|---|
| Speciality | Clinic/center - Federally Qualified Health Center (fqhc) |
| Location | 109 E 5th St, Caruthersville, Missouri |
| Authorized Official Name and Position | Christopher Jones (CEO) |
| Authorized Official Contact | 5737482404 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
6738 State Highway 77 Benton MO 63736-8238 Ph: (573) 313-2500 | 109 E 5th St Caruthersville MO 63830-1417 Ph: (573) 359-9803 |
| NPI Number | 1053700435 |
|---|---|
| Provider Enumeration Date | 01/22/2015 |
| Last Update Date | 01/17/2025 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1053700435 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1223G0001X | Dentist - General Practice | (* (Not Available)) | Secondary |
| 261QF0400X | Clinic/center - Federally Qualified Health Center (fqhc) | (* (Not Available)) | Primary |