Provider Demographics
NPI:1134128721
Name:ELK RIVER HEALTH SERVICES, INC.
Entity Type:Organization
Organization Name:ELK RIVER HEALTH SERVICES, INC.
Other - Org Name:ANDERSON RURAL HEALTH CLINIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:VICKI
Authorized Official - Middle Name:
Authorized Official - Last Name:PLUMLEE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:417-845-6984
Mailing Address - Street 1:PO BOX 750
Mailing Address - Street 2:104 E MAIN STREET
Mailing Address - City:ANDERSON
Mailing Address - State:MO
Mailing Address - Zip Code:64831-0750
Mailing Address - Country:US
Mailing Address - Phone:417-845-6984
Mailing Address - Fax:417-845-6976
Practice Address - Street 1:104 E MAIN STREET
Practice Address - Street 2:
Practice Address - City:ANDERSON
Practice Address - State:MO
Practice Address - Zip Code:64831-0750
Practice Address - Country:US
Practice Address - Phone:417-845-6984
Practice Address - Fax:417-845-6976
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-07-18
Last Update Date:2014-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO261QR1300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR1300XAmbulatory Health Care FacilitiesClinic/CenterRural Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO507681385Medicaid
MO596813816Medicaid
MO263827Medicare Oscar/Certification