Provider Demographics
NPI:1750422457
Name:SALT RIVER COMMUNITY HEALTH CENTER
Entity type:Organization
Organization Name:SALT RIVER COMMUNITY HEALTH CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:JOAN
Authorized Official - Middle Name:F
Authorized Official - Last Name:HYNEK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:573-221-4422
Mailing Address - Street 1:3145 HIGHWAY 61
Mailing Address - Street 2:
Mailing Address - City:HANNIBAL
Mailing Address - State:MO
Mailing Address - Zip Code:63401-6588
Mailing Address - Country:US
Mailing Address - Phone:573-221-4422
Mailing Address - Fax:573-221-4470
Practice Address - Street 1:3145 HIGHWAY 61
Practice Address - Street 2:
Practice Address - City:HANNIBAL
Practice Address - State:MO
Practice Address - Zip Code:63401-6588
Practice Address - Country:US
Practice Address - Phone:573-221-1166
Practice Address - Fax:573-221-1214
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-08
Last Update Date:2010-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO19782870261QM0801X, 261QC1500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QC1500XAmbulatory Health Care FacilitiesClinic/CenterCommunity Health
No261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)