Organization
SALT RIVER COMMUNITY HEALTH CENTER
Active
Parent organization
SALT RIVER COMMUNITY HEALTH CENTER
Other names
Salt River Community Dental Center
Organization subpart
Yes
Provider details
NPI number
Legal business name
SALT RIVER COMMUNITY HEALTH CENTER
Authorized official
JOAN F HYNEK (EXECUTIVE DIRECTOR)
(573) 221-4422
Entity
Organization
Contact information
Practice address
248 N MORGAN ST, KAHOKA, MO 63445-1433
(660) 727-1500
(660) 727-1502
Mailing address
3145 N HIGHWAY 61, HANNIBAL, MO 63401-6588
(573) 221-4422
(537) 221-4403
Taxonomy
Speciality
Code
Description
License number
State
261QM1300X
Multi-Specialty Clinic/Center
Primary
19782870
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1750422457
NPI (PARENT ORGANIZATION)
MO
01
—
833215221
MEDICARE-PTAN
MO
Enumeration date
03/05/2010
Last updated
05/01/2011
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