| NPI | 1467114686 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MARK CONOVER Chief Revenue Officer 573-603-1460 |
| Organization Subpart ? | Yes |
| Primary Taxonomy | 261QF0400X Clinic/Center Federally Qualified Health Center (FQHC) |
| Additional Taxonomies | 251S00000X Community/Behavioral Health |
| 261QD0000X Clinic/Center Dental | |
| 261QP2300X Clinic/Center Primary Care | |
| Enumeration Date | 2021-10-06 |
| Last Update Date | 2021-10-06 |