Bootheel Primary Care Clinic - Kennett

LBN: Pemiscot County Memorial Hospital
Bootheel Primary Care Clinic - Kennett is an health care organization with primary practice located at 1231 1St St Ste 5 , Kennett MO 63857-2521. The organization recently has only one registered license in Ambulatory Health Care Facilities / Rural Health, which is considered as the primary health care specialty. Pemiscot County Memorial Hospital can be contacted via phone (573) 888-8828, or through White-Wagoner, Joan via phone (573) 359-3612.

Contact Information

Primary practice address
1231 1St St Ste 5 Kennett MO 63857-2521
Phone: (573) 888-8828
Fax: (573) 888-8830
Website:
Map and Directions
Authorized official contact:
Name: White-Wagoner, Joan
Phone: (573) 359-3612

Health care specialties

SpecialtyCodeLicense #State
Ambulatory Health Care Facilities / Rural Health 261QR1300X

Profile Details

NPI number 1992807390
LBN Legal business name Pemiscot County Memorial Hospital
DBA Doing business as Bootheel Primary Care Clinic - Kennett
Authorized official White-Wagoner, Joan
Entity Organization
Organization subpart 1 No
Enumeration date Sep 5th, 2006
Last updated Sep 27th, 2023 - about last year

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.

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Identifiers

StateTypeNumberIssuer
All States NPI 1992807390 NPPES
Missouri MEDICAID 598517803

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