| NPI | 1164945168 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MARK CONOVER Chief Revenue Officer 573-603-1460 |
| Organization Subpart ? | No |
| Primary Taxonomy | 251S00000X Community/Behavioral Health |
| Additional Taxonomies | 261QF0400X Clinic/Center, Federally Qualified Health Center (FQHC) |
| 261QM1300X Clinic/Center, Multi-Specialty | |
| Enumeration Date | 2017-07-21 |
| Last Update Date | 2022-06-10 |