Northeast Missouri Dental Clinic
LBN: Northeast Missouri Health Council, Inc.
Northeast Missouri Dental Clinic is an health care organization with primary practice located at 402 W Jefferson St , Kirksville MO 63501-3407. The organization recently has 3 registered licenses in different health care specialties including Dental Providers / Dental Public Health, Dental Providers / Dental Hygienist, Ambulatory Health Care Facilities / Federally Qualified Health Center (FQHC). Ambulatory Health Care Facilities / Federally Qualified Health Center (FQHC) is the primary health care specialty.
Northeast Missouri Health Council, Inc. can be contacted via phone (660) 665-2741, or through Grimm, Andrew H. via phone (660) 627-5757.
Contact Information
Primary practice address
402 W Jefferson St
Kirksville MO 63501-3407
Phone: (660) 665-2741
Fax: (660) 665-3109
Website:
Health care specialties
| Specialty | Code | License # | State |
|---|---|---|---|
| Dental Providers / Dental Public Health | 1223D0001X | 2001012903 | Missouri |
| Dental Providers / Dental Public Health | 1223D0001X | 2006007559 | Missouri |
| Dental Providers / Dental Hygienist | 124Q00000X | 003847 | Missouri |
| Ambulatory Health Care Facilities / Federally Qualified Health Center (FQHC) | 261QF0400X | Missouri |
Profile Details
| NPI number | 1972649986 |
|---|---|
| LBN Legal business name | Northeast Missouri Health Council, Inc. |
| DBA Doing business as | Northeast Missouri Dental Clinic |
| Authorized official | Grimm, Andrew H. |
| Entity | Organization |
| Organization subpart 1 | Yes |
| Enumeration date | Jan 29th, 2007 |
| Last updated | Oct 12th, 2012 - about 12 years ago |
1 Some organizations, which are providing health care services, may consist of units or departments that provide different types of health care services or have several separate physical locations, where health care service is provided. These units, departments or physical locations are not themselves legal entities. However, each of them is part of the organization, which is a legal entity. The organization may decide whether its subparts, if it has any, should have their own NPI numbers. In case a subpart conducts any HIPAA standard transactions by itself, without its parent's involvement, it must have its own NPI number.
Identifiers
| State | Type | Number | Issuer |
|---|---|---|---|
| All States | NPI | 1972649986 | NPPES |
| Missouri | MEDICAID | 507477404 |
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