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Organization

NORTHEAST MISSOURI HEALTH COUNCIL, INC.

Active
Parent organization
NORTHEAST MISSOURI HEALTH COUNCIL, INC.
Other names
Northeast Missouri Family Health Clinic
Organization subpart
Yes

Provider details

NPI number
Legal business name
NORTHEAST MISSOURI HEALTH COUNCIL, INC.
Authorized official
ANDREW H. GRIMM (EXECUTIVE DIRECTOR)
(660) 627-5757
Entity
Organization

Contact information

Practice address
104 E JACKSON ST, EDINA, MO 63537-1335
(660) 397-3517
(660) 397-2307
Mailing address
1416 CROWN DR, KIRKSVILLE, MO 63501-2548
(660) 627-5757
(660) 627-5802

Taxonomy

Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
107529
MO
207Q00000X
Family Medicine Physician
R9D62
MO
261QF0400X
Federally Qualified Health Center (FQHC)
Primary
MO

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
503351819
MO
Enumeration date
01/29/2007
Last updated
11/11/2015
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