Provider Demographics
NPI:1720789787
Name:SOUTH CENTRAL MISSOURI COMMUNITY HEALTH CENTER
Entity Type:Organization
Organization Name:SOUTH CENTRAL MISSOURI COMMUNITY HEALTH CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CREDENTIALING SPECIALIST
Authorized Official - Prefix:
Authorized Official - First Name:ELIZABETH
Authorized Official - Middle Name:
Authorized Official - Last Name:SPARKS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:573-426-2407
Mailing Address - Street 1:1081 E 18TH ST
Mailing Address - Street 2:
Mailing Address - City:ROLLA
Mailing Address - State:MO
Mailing Address - Zip Code:65401-2448
Mailing Address - Country:US
Mailing Address - Phone:573-426-2407
Mailing Address - Fax:573-426-6723
Practice Address - Street 1:509 E 10TH ST
Practice Address - Street 2:
Practice Address - City:ROLLA
Practice Address - State:MO
Practice Address - Zip Code:65401-3302
Practice Address - Country:US
Practice Address - Phone:573-426-2407
Practice Address - Fax:573-426-6723
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:SOUTH CENTRAL MISSOURI COMMUNITY HEALTH CENTER
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2023-03-15
Last Update Date:2023-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QF0400XAmbulatory Health Care FacilitiesClinic/CenterFederally Qualified Health Center (FQHC)