Provider Demographics
NPI:1548562994
Name:PRIVATE HEALTH CORPORATION
Entity Type:Organization
Organization Name:PRIVATE HEALTH CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:ROSS
Authorized Official - Last Name:CLYMER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:417-782-6169
Mailing Address - Street 1:2401 S JACKSON AVE
Mailing Address - Street 2:
Mailing Address - City:JOPLIN
Mailing Address - State:MO
Mailing Address - Zip Code:64804-1938
Mailing Address - Country:US
Mailing Address - Phone:417-782-6169
Mailing Address - Fax:417-782-1973
Practice Address - Street 1:2401 S JACKSON AVE
Practice Address - Street 2:
Practice Address - City:JOPLIN
Practice Address - State:MO
Practice Address - Zip Code:64804-1938
Practice Address - Country:US
Practice Address - Phone:417-782-6169
Practice Address - Fax:417-782-1973
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-11-17
Last Update Date:2010-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251K00000XAgenciesPublic Health or Welfare