# GREAT MINES HEALTH CENTER

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1669654638
- **Authorized official:** MS. DONNA L BLOUNT (OFFICE MANAGER)
- **Authorized official phone:** (573) 438-9355

## Contact information

- **Practice address:** 123 W PRATT ST, DE SOTO, MO 63020-2107
- **Practice address phone:** (636) 586-2522
- **Practice address fax:** (636) 586-2546
- **Mailing address:** 123 W PRATT ST, DE SOTO, MO 63020-2107
- **Mailing address phone:** (636) 586-2522
- **Mailing address fax:** (636) 586-2546

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207Q00000X | Family Medicine Physician | — | NULL | Yes |
| 207Q00000X | Family Medicine Physician | — | — | Yes |

## Other

- **Enumeration date:** 12/03/2007
- **Last updated:** 02/04/2008