Provider Demographics
NPI:1477821684
Name:KENNETT HMA LLC
Entity Type:Organization
Organization Name:KENNETT HMA LLC
Other - Org Name:TWIN RIVERS FAMILY PRACTICE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR/DELEGATED OFFICIAL
Authorized Official - Prefix:
Authorized Official - First Name:PAULA
Authorized Official - Middle Name:M
Authorized Official - Last Name:LALOR
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:615-925-4565
Mailing Address - Street 1:1301 1ST ST
Mailing Address - Street 2:
Mailing Address - City:KENNETT
Mailing Address - State:MO
Mailing Address - Zip Code:63857-2525
Mailing Address - Country:US
Mailing Address - Phone:573-888-4522
Mailing Address - Fax:573-888-5525
Practice Address - Street 1:1231 1ST ST
Practice Address - Street 2:SUITE 5
Practice Address - City:KENNETT
Practice Address - State:MO
Practice Address - Zip Code:63857-2527
Practice Address - Country:US
Practice Address - Phone:573-888-8690
Practice Address - Fax:573-517-1085
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-12-02
Last Update Date:2018-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR1300XAmbulatory Health Care FacilitiesClinic/CenterRural Health