Jordan Valley Community Health Center | |
649 E Elm St Republic MO 65738-1505 | |
(417) 851-1565 | |
Not Available |
Full Name | Jordan Valley Community Health Center |
---|---|
Speciality | Clinic/center - Federally Qualified Health Center (fqhc) |
Location | 649 E Elm St, Republic, Missouri |
Authorized Official Name and Position | Kenneth Brooks Miller (CEO) |
Authorized Official Contact | 4178511551 |
Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
Mailing Address | Practice Location Address |
---|---|
Jordan Valley Community Health Center 440 E Tampa St Springfield MO 65806-1131 Ph: (417) 831-0150 | Jordan Valley Community Health Center 649 E Elm St Republic MO 65738-1505 Ph: (417) 851-1565 |
NPI Number | 1457778094 |
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Provider Enumeration Date | 03/20/2014 |
Last Update Date | 05/18/2023 |
Identifier | Type | State | Issuer |
---|---|---|---|
1457778094 | NPI | - | NPPES |
500015254 | Medicaid | MO |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
261QF0400X | Clinic/center - Federally Qualified Health Center (fqhc) | (* (Not Available)) | Primary |
Jordan Valley Community Health Center Primary Care Clinic Medicare: Medicare Enrolled Practice Location: 649 E Elm St, Republic, MO 65738 Phone: 417-851-1551 | |
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