Provider Demographics
NPI:1801034848
Name:GREATER HALLSVILLE AREA DEVELOPMENT AND RURAL HEALTH CORPORATION
Entity Type:Organization
Organization Name:GREATER HALLSVILLE AREA DEVELOPMENT AND RURAL HEALTH CORPORATION
Other - Org Name:HALLSVILLE AREA FAMILY CLINIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CHAIRMAN
Authorized Official - Prefix:
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:
Authorized Official - Last Name:SCHLOOT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:573-696-0500
Mailing Address - Street 1:11821 N BURG RD
Mailing Address - Street 2:
Mailing Address - City:HALLSVILLE
Mailing Address - State:MO
Mailing Address - Zip Code:65255-9781
Mailing Address - Country:US
Mailing Address - Phone:573-696-0500
Mailing Address - Fax:573-696-0509
Practice Address - Street 1:501 N ROUTE B
Practice Address - Street 2:
Practice Address - City:HALLSVILLE
Practice Address - State:MO
Practice Address - Zip Code:65255-9266
Practice Address - Country:US
Practice Address - Phone:573-696-0500
Practice Address - Fax:573-696-0509
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-01-29
Last Update Date:2016-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QR1300XAmbulatory Health Care FacilitiesClinic/CenterRural HealthGroup - Multi-Specialty
No207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO268991Medicare Oscar/Certification