Organization
GREAT MINES HEALTH CENTER
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. MICHAEL L JOHNSON (CEO)
(573) 438-9355
Entity
Organization
Contact information
Practice address
#1 SOUTHTOWNE DRIVE, POTOSI, MO 63664-1455
(573) 438-9355
(573) 438-7892
Mailing address
#1 SOUTHTOWNE DRIVE, POTOSI, MO 63664-1455
(573) 438-9355
(573) 438-7892
Taxonomy
Speciality
Code
Description
License number
State
261QF0400X
Federally Qualified Health Center (FQHC)
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
26-1878
UNITED GOVERNMENT SERVICE
MO
05
—
509215109
—
MO
Enumeration date
08/29/2005
Last updated
06/23/2009
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