# HAYTI MEDICAL CLINIC, INC

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- **Entity:** Organization
- **Status:** Active
- **Other names:** Extended Health Systems Medical Clinic
- **Organization subpart:** No

## Provider details

- **NPI number:** 1851373906
- **Authorized official:** GLENN HAYNES (CEO)
- **Authorized official phone:** (573) 359-2930

## Contact information

- **Practice address:** 1502 WARD AVE, CARUTHERSVILLE, MO 63830-2571
- **Practice address phone:** (573) 333-4244
- **Practice address fax:** (573) 333-4551
- **Mailing address:** PO BOX 37, HAYTI, MO 63851-0037
- **Mailing address phone:** (573) 359-2930
- **Mailing address fax:** (573) 359-1304

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 261QR1300X | Rural Health Clinic/Center | — | NULL | Yes |

## Other

- **Enumeration date:** 11/15/2005
- **Last updated:** 08/22/2020