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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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