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Organization
BONNE TERRE HEALTH CLINIC LLC
Active
Organization
BONNE TERRE HEALTH CLINIC LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. ANDREW JOHN NINICHUCK M.D. (MEMBER)
(573) 358-3343
Entity
Organization
Contact information
Practice address
55 NESBIT DR, BONNE TERRE, MO 63628-1353
(573) 358-3343
(573) 358-5458
Mailing address
55 NESBIT DR, BONNE TERRE, MO 63628-1353
(573) 358-3343
(573) 358-5458
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
102387
MO
261QR1300X
Rural Health Clinic/Center
Primary
102387
MO
Other
Enumeration date
11/20/2008
Last updated
09/24/2009
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