Organization
SOUTH CENTRAL MISSOURI COMMUNITY HEALTH CENTER
Active
Other names
Your Community Health Center
Organization subpart
No
Provider details
NPI number
Authorized official
KELLY MILLER (CEO)
(573) 426-6712
Entity
Organization
Contact information
Practice address
200 N MAIN ST, SUITE 51G, ROLLA, MO 65401-3061
(573) 426-6712
(573) 426-6735
Mailing address
200 N MAIN ST, SUITE 51G, ROLLA, MO 65401-3061
(573) 426-6712
(573) 426-6735
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1164669172
—
MO
Enumeration date
05/09/2017
Last updated
05/09/2017
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