Organization
GREAT MINES HEALTH CENTER
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MICHAEL JOHNSON (MANAGER)
(618) 277-9533
Entity
Organization
Contact information
Practice address
1 BLACK KNIGHT DR RM 1, FARMINGTON, MO 63640-2930
(573) 438-9355
Mailing address
1 SOUTHTOWNE DR, POTOSI, MO 63664-5729
(573) 438-9355
Taxonomy
Speciality
Code
Description
License number
State
261QF0400X
Federally Qualified Health Center (FQHC)
Primary
—
—
Other
Enumeration date
03/18/2021
Last updated
05/05/2021
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