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18627 Jackson St Hermitage MO 65668-8204 | |
(417) 745-2134 | |
(417) 745-2135 |
Full Name | |
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Speciality | Clinic/center - Federally Qualified Health Center (fqhc) |
Location | 18627 Jackson St, Hermitage, Missouri |
Authorized Official Name and Position | Scott D Crouch (CEO) |
Authorized Official Contact | 4177452121 |
Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
Mailing Address | Practice Location Address |
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Po Box 125 Hermitage MO 65668-0125 Ph: (417) 745-2121 | 18627 Jackson St Hermitage MO 65668-8204 Ph: (417) 745-2134 |
NPI Number | 1326453408 |
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Provider Enumeration Date | 06/26/2014 |
Last Update Date | 01/09/2025 |
Certification Date | 01/09/2025 |
Identifier | Type | State | Issuer |
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1326453408 | NPI | - | NPPES |
1235562836 | Medicaid | MO |