Organization
NORTHEAST MISSOURI HEALTH COUNCIL, INC.
Active
Parent organization
NORTHEAST MISSOURI HEALTH COUNCIL, INC.
Other names
Northeast Missouri Dental 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
402 W JEFFERSON ST, KIRKSVILLE, MO 63501-3407
(660) 665-2741
(660) 665-3109
Mailing address
1416 CROWN DR, P O BOX 1027, KIRKSVILLE, MO 63501-2548
(660) 627-5757
(660) 627-5802
Taxonomy
Speciality
Code
Description
License number
State
1223D0001X
Public Health Dentistry
2001012903
MO
1223D0001X
Public Health Dentistry
2006007559
MO
124Q00000X
Dental Hygienist
003847
MO
261QF0400X
Federally Qualified Health Center (FQHC)
Primary
—
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
507477404
—
MO
Enumeration date
01/29/2007
Last updated
10/12/2012
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