Organization
HOLDEN FAMILY CARE, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MS. CAROL JEAN JACKSON (OFFICE MANAGER)
(816) 732-6010
Entity
Organization
Contact information
Practice address
612 E 10TH ST, HOLDEN, MO 64040-9421
(816) 732-6010
(816) 732-6011
Mailing address
612 E 10TH ST, HOLDEN, MO 64040-9421
(816) 732-6010
(816) 732-6011
Taxonomy
Speciality
Code
Description
License number
State
261QR1300X
Rural Health Clinic/Center
Primary
076670
MO
363L00000X
Nurse Practitioner
076670
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1205154606
—
MO
Enumeration date
05/10/2010
Last updated
04/10/2015
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