Organization
DEXTER HOSPITAL LLC
Active
Other names
JIBBEN MEDICAL
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. SUE ANN WILLIAMS (CLINIC ADMINISTRATOR)
(573) 624-1640
Entity
Organization
Contact information
Practice address
1525 W BUSINESS HWY 60, DEXTER, MO 63841
(573) 624-8447
(573) 624-4312
Mailing address
PO BOX 368, DEXTER, MO 63841-0368
(573) 624-3165
(573) 624-3157
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
—
—
261QR1300X
Rural Health Clinic/Center
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
504910001
—
MO
01
—
DC5219
MEDICARE RAILROAD
MO
Enumeration date
11/07/2006
Last updated
09/11/2008
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