Provider Demographics
NPI:1871887646
Name:SIKESTON RURAL HEALTH CENTER LLC
Entity type:Organization
Organization Name:SIKESTON RURAL HEALTH CENTER LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:TERRY
Authorized Official - Middle Name:
Authorized Official - Last Name:COLE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:573-471-0466
Mailing Address - Street 1:1226 LINN ST
Mailing Address - Street 2:SUITE B
Mailing Address - City:SIKESTON
Mailing Address - State:MO
Mailing Address - Zip Code:63801-5200
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1226 LINN ST
Practice Address - Street 2:SUITE B
Practice Address - City:SIKESTON
Practice Address - State:MO
Practice Address - Zip Code:63801-5200
Practice Address - Country:US
Practice Address - Phone:573-472-3700
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-06-08
Last Update Date:2011-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR1300XAmbulatory Health Care FacilitiesClinic/CenterRural Health