Basic Information
| Provider Information | |||||||||
| NPI: | 1245874510 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | RURAL ALLIANCE FOR BETTER FAMILY HEALTH | ||||||||
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| OtherOrganizationName: | SOUTHERN MISSOURI COMMUNITY HEALTH CENTER | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1137 INDEPENDENCE DR | ||||||||
| Address2: | |||||||||
| City: | WEST PLAINS | ||||||||
| State: | MO | ||||||||
| PostalCode: | 657754221 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4172558464 | ||||||||
| FaxNumber: | 4172559732 | ||||||||
| Practice Location | |||||||||
| Address1: | 401 E WALNUT ST | ||||||||
| Address2: | |||||||||
| City: | THAYER | ||||||||
| State: | MO | ||||||||
| PostalCode: | 657911533 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4172558464 | ||||||||
| FaxNumber: | 4172559732 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/30/2019 | ||||||||
| LastUpdateDate: | 02/05/2020 | ||||||||
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| AuthorizedOfficialLastName: | ADCOCK | ||||||||
| AuthorizedOfficialFirstName: | BRYAN | ||||||||
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| AuthorizedOfficialTitleorPosition: | CEO | ||||||||
| AuthorizedOfficialTelephone: | 4172558464 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| NPICertificationDate: | 02/05/2020 | ||||||||
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.