1407919897 NPI number — STEELE FAMILY RURAL HEALTH CLINIC, LLC

Table of content: (NPI 1407919897)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1407919897 NPI number — STEELE FAMILY RURAL HEALTH CLINIC, LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
STEELE FAMILY RURAL HEALTH CLINIC, LLC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
6
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1407919897
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/02/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
135 MAIN STREET
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
GIDEON
Provider Business Mailing Address State Name:
MO
Provider Business Mailing Address Postal Code:
63848-9253
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
573-448-3800
Provider Business Mailing Address Fax Number:
573-448-8909

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
135 SOUTH MAIN
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
GIDEON
Provider Business Practice Location Address State Name:
MO
Provider Business Practice Location Address Postal Code:
63848-9253
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
573-448-3800
Provider Business Practice Location Address Fax Number:
573-448-8909
Provider Enumeration Date:
12/18/2006

Additional Information

Authorized Official

Authorized Official Last Name:
MCPHERSON
Authorized Official First Name:
TIMOTHY
Authorized Official Middle Name:
WILLIAM
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
573-695-2181

Provider Taxonomy Codes

  • Taxonomy code: 207Q00000X , with the licence number:  R9E31 , registered in the state of MO ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





Copyright © 2007-2025 www.npivalidator.com