Provider Demographics
NPI:1295865624
Name:ELK RIVER HEALTH SERVICES, INC.
Entity Type:Organization
Organization Name:ELK RIVER HEALTH SERVICES, INC.
Other - Org Name:SOUTHWEST CITY COMMUNITY CLINIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR OF CLINICS
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:417-762-3287
Mailing Address - Street 1:PO BOX 160
Mailing Address - Street 2:
Mailing Address - City:SOUTH WEST CITY
Mailing Address - State:MO
Mailing Address - Zip Code:64863-0160
Mailing Address - Country:US
Mailing Address - Phone:417-762-3287
Mailing Address - Fax:417-762-3255
Practice Address - Street 1:109 N BROADWAY
Practice Address - Street 2:
Practice Address - City:SOUTH WEST CITY
Practice Address - State:MO
Practice Address - Zip Code:64863-0160
Practice Address - Country:US
Practice Address - Phone:417-762-3287
Practice Address - Fax:417-762-3255
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-06
Last Update Date:2014-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO506813815Medicaid
MO506813815Medicaid