Organization
GREAT MINES HEALTH CENTER
Active
Organization subpart
No
Provider details
NPI number
Authorized official
GREGORY A ROEBACK MA, NCC, LPC, PHR, S (CHIEF EXECUTIVE OFFICER)
(573) 438-9355
Entity
Organization
Contact information
Practice address
10788 STATE HIGHWAY A RM 128, RICHWOODS, MO 63071-2548
(573) 438-9355
(573) 438-7892
Mailing address
PO BOX 761, POTOSI, MO 63664-0761
(573) 435-9355
(573) 438-7892
Taxonomy
Speciality
Code
Description
License number
State
261QF0400X
Federally Qualified Health Center (FQHC)
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
H80CS06670-13-02
HRSA
—
Enumeration date
01/22/2019
Last updated
01/22/2019
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