Provider Demographics
NPI:1407919897
Name:STEELE FAMILY RURAL HEALTH CLINIC, LLC
Entity Type:Organization
Organization Name:STEELE FAMILY RURAL HEALTH CLINIC, LLC
Other - Org Name:GIDEON MEDICAL CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:TIMOTHY
Authorized Official - Middle Name:WILLIAM
Authorized Official - Last Name:MCPHERSON
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:573-695-2181
Mailing Address - Street 1:135 MAIN STREET
Mailing Address - Street 2:
Mailing Address - City:GIDEON
Mailing Address - State:MO
Mailing Address - Zip Code:63848-9253
Mailing Address - Country:US
Mailing Address - Phone:573-448-3800
Mailing Address - Fax:573-448-8909
Practice Address - Street 1:135 SOUTH MAIN
Practice Address - Street 2:
Practice Address - City:GIDEON
Practice Address - State:MO
Practice Address - Zip Code:63848-9253
Practice Address - Country:US
Practice Address - Phone:573-448-3800
Practice Address - Fax:573-448-8909
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-18
Last Update Date:2007-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MOR9E31207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO268958Medicare PIN
MOA10540Medicare UPIN