Organization
NORTHEAST MISSOURI HEALTH COUNCIL, INC.
Active
Other names
OB/GYN Specialty Group/Northeast Pediatrics
Organization subpart
No
Provider details
NPI number
Authorized official
ANDREW H. GRIMM (EXECUTIVE DIRECTOR)
(660) 627-5757
Entity
Organization
Contact information
Practice address
402 W JEFFERSON ST, KIRKSVILLE, MO 63501-3407
(660) 665-3555
Mailing address
1416 CROWN DR, KIRKSVILLE, MO 63501-2548
(660) 627-5757
(660) 627-5802
Taxonomy
Speciality
Code
Description
License number
State
207V00000X
Obstetrics & Gynecology Physician
2004027805
MO
207V00000X
Obstetrics & Gynecology Physician
2009006697
MO
207V00000X
Obstetrics & Gynecology Physician
R5810
MO
208000000X
Pediatrics Physician
2005037590
MO
208000000X
Pediatrics Physician
2006022612
MO
2080P0203X
Pediatric Critical Care Medicine Physician
2009001623
MO
261QF0400X
Federally Qualified Health Center (FQHC)
Primary
—
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
503351801
—
MO
Enumeration date
01/29/2007
Last updated
10/30/2012
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