Provider Demographics
NPI:1518095470
Name:BETTY JEAN KERR PEOPLE'S HEALTH CENTERS
Entity Type:Organization
Organization Name:BETTY JEAN KERR PEOPLE'S HEALTH CENTERS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT & CEO
Authorized Official - Prefix:
Authorized Official - First Name:DWAYNE
Authorized Official - Middle Name:
Authorized Official - Last Name:BUTLER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:314-367-7848
Mailing Address - Street 1:11642 W FLORISSANT AVE
Mailing Address - Street 2:
Mailing Address - City:FLORISSANT
Mailing Address - State:MO
Mailing Address - Zip Code:63033-6723
Mailing Address - Country:US
Mailing Address - Phone:314-838-8220
Mailing Address - Fax:314-838-4007
Practice Address - Street 1:11642 W FLORISSANT AVE
Practice Address - Street 2:
Practice Address - City:FLORISSANT
Practice Address - State:MO
Practice Address - Zip Code:63033-6723
Practice Address - Country:US
Practice Address - Phone:314-838-8220
Practice Address - Fax:314-838-4007
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-01
Last Update Date:2014-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QF0400XAmbulatory Health Care FacilitiesClinic/CenterFederally Qualified Health Center (FQHC)
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO1518095470Medicaid
MO500543343Medicaid
MO500543343Medicaid