Basic Information
Provider Information | |||||||||
NPI: | 1164488680 | ||||||||
EntityType: | 2 | ||||||||
ReplacementNPI: |   | ||||||||
OrganizationName: | RURAL ALLIANCE FOR BETTER FAMILY HEALTH | ||||||||
LastName: |   | ||||||||
FirstName: |   | ||||||||
MiddleName: |   | ||||||||
NamePrefix: |   | ||||||||
NameSuffix: |   | ||||||||
Credential: |   | ||||||||
OtherOrganizationName: | SOUTHERN MISSOURI COMMUNITY HEALTH CENTER THAYER CLINIC | ||||||||
OtherOrganizationType: | 3 | ||||||||
OtherLastName: |   | ||||||||
OtherFirstName: |   | ||||||||
OtherMiddleName: |   | ||||||||
OtherNamePrefix: |   | ||||||||
OtherNameSuffix: |   | ||||||||
OtherCredential: |   | ||||||||
OtherLastNameType: |   | ||||||||
Mailing Information | |||||||||
Address1: | 1137 INDEPENDENCE DR | ||||||||
Address2: |   | ||||||||
City: | WEST PLAINS | ||||||||
State: | MO | ||||||||
PostalCode: | 657754221 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 4172558464 | ||||||||
FaxNumber: | 4172559741 | ||||||||
Practice Location | |||||||||
Address1: | RR 3 BOX 3707 | ||||||||
Address2: |   | ||||||||
City: | THAYER | ||||||||
State: | MO | ||||||||
PostalCode: | 657919306 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 4172642990 | ||||||||
FaxNumber: | 4172642993 | ||||||||
Other Information | |||||||||
ProviderEnumerationDate: | 04/24/2006 | ||||||||
LastUpdateDate: | 01/15/2015 | ||||||||
NPIDeactivationReasonCode: |   | ||||||||
NPIDeactivationDate: |   | ||||||||
NPIReactivationDate: |   | ||||||||
ProviderGenderCode: |   | ||||||||
AuthorizedOfficialLastName: | RICHARDS | ||||||||
AuthorizedOfficialFirstName: | PATRICIA | ||||||||
AuthorizedOfficialMiddleName: | J | ||||||||
AuthorizedOfficialTitleorPosition: | CEO | ||||||||
AuthorizedOfficialTelephone: | 4172558464 | ||||||||
IsSoleProprietor: |   | ||||||||
IsOrganizationSubpart: | Y | ||||||||
ParentOrganizationLBN: | RURAL ALLIANCE FOR BETTER FAMILY HEALTH | ||||||||
AuthorizedOfficialNamePrefix: |   | ||||||||
AuthorizedOfficialNameSuffix: |   | ||||||||
AuthorizedOfficialCredential: |   | ||||||||
NPICertificationDate: |   |
Taxonomy Information
Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 261QF0400X |   |   | Y |   | Ambulatory Health Care Facilities | Clinic/Center | Federally Qualified Health Center (FQHC) |
No ID Information.