Organization
GREAT MINES HEALTH CENTER
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. MICHAEL L. JOHNSON MBA (CEO)
(573) 438-8321
Entity
Organization
Contact information
Practice address
530 N MIDDLE ST, FARMINGTON, MO 63640-1570
(573) 756-8660
(573) 756-5414
Mailing address
530 N MIDDLE ST, FARMINGTON, MO 63640-1570
(573) 756-8660
(573) 756-5414
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
—
—
261QF0400X
Federally Qualified Health Center (FQHC)
Primary
—
—
Other
Enumeration date
12/03/2007
Last updated
06/11/2013
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