| Jordan Valley Community Health Center-pharmacy | |
|
860 Lynn St Lebanon MO 65536-3832 | |
| (417) 831-0150 | |
| Not Available |
| Full Name | Jordan Valley Community Health Center-pharmacy |
|---|---|
| Speciality | Clinic/center - Federally Qualified Health Center (fqhc) |
| Location | 860 Lynn St, Lebanon, Missouri |
| Authorized Official Name and Position | Kenneth Brooks Miller (EXECUTIVE DIRECTOR) |
| Authorized Official Contact | 4178310150 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Jordan Valley Community Health Center-pharmacy 440 E Tampa St Springfield MO 65806-1131 Ph: (417) 851-1551 | Jordan Valley Community Health Center-pharmacy 860 Lynn St Lebanon MO 65536-3832 Ph: (417) 831-0150 |
| NPI Number | 1477657658 |
|---|---|
| Provider Enumeration Date | 09/11/2006 |
| Last Update Date | 12/02/2021 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1477657658 | NPI | - | NPPES |
| PENDING | Medicaid | MO |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QF0400X | Clinic/center - Federally Qualified Health Center (fqhc) | (* (Not Available)) | Primary |
| 3336C0002X | Pharmacy - Clinic Pharmacy | (* (Not Available)) | Secondary |
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