Organization
COMMUNITY HOSPITAL ASSOCIATION
Active
Other names
Rock Port Family Medicine, Community Hospital-Fairfax
Organization subpart
No
Provider details
NPI number
Authorized official
JON P DAVIS (CFO)
(660) 686-2320
Entity
Organization
Contact information
Practice address
100 E CASS ST, ROCK PORT, MO 64482-1528
(660) 744-5361
(660) 744-2247
Mailing address
100 E CASS STREET, ROCK PORT, MO 64482-1528
(660) 744-5361
(660) 744-2247
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
—
MO
261QR1300X
Rural Health Clinic/Center
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
29516017
BCBS KANSAS CITY MO
MO
05
—
505428102
—
MO
Enumeration date
06/23/2005
Last updated
12/18/2020
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