Organization
MISSOURI BAPTIST HOSPITAL OF SULLIVAN
Active
Other names
Riverside Medical Clinic
Organization subpart
No
Provider details
NPI number
Authorized official
MR. AUGUSTO A NORONHA II (VICE PRESIDENT FINANCE AND CFO)
(314) 996-5118
Entity
Organization
Contact information
Practice address
101 PROGRESS PKWY, SULLIVAN, MO 63080-2359
(573) 486-3555
(314) 996-3610
Mailing address
670 MASON RIDGE CENTER DR, SUITE 300, SAINT LOUIS, MO 63141-8573
(314) 996-7644
(314) 996-7658
Taxonomy
Speciality
Code
Description
License number
State
261QR1300X
Rural Health Clinic/Center
Primary
355-24
MO
Other
Enumeration date
10/11/2006
Last updated
12/02/2011
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