BONNE TERRE HEALTHCARE CLINIC LLC NPI 1962043802

NPI Information

NPI: 1962043802
Provider Name: BONNE TERRE HEALTHCARE CLINIC LLC
Classification: Nurse Practitioner - 363LF0000X
Entity Type: Organization

Specialization: Family

CLIA Number: 26D2178139

Address:
11 S DIVISION ST STE A
BONNE TERRE, MO
ZIP 63628
Phone: (573) 723-1100
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BONNE TERRE HEALTHCARE CLINIC LLC is a family nurse practitioner in Bonne Terre, MO. BONNE TERRE HEALTHCARE CLINIC LLC NPI is 1962043802. The provider is registered as an organization entity type and is a multi-specialty group.

The provider's business location address is:

11 S DIVISION ST STE A
BONNE TERRE, MO
ZIP 63628-701
Phone: (573) 723-1100
Fax: (573) 723-1130

The provider's authorized official is Mary Elizabeth Chandler .
The authorized official title is Owner/provider and has the following contact phone number (573) 723-1100.

The CLIA number assigned to this NPI record is 26D2178139 - physician office with a certificate type of Certificate of Waiver.

The enumeration date for this NPI number is 10/2/2019 and was last updated on 2/25/2024.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No.	Taxonomy Code	Taxonomy Clasification	Taxonomy Specialization	Primary
1	101YM0800X	Counselor	Mental Health	No
2	363LP0200X	Nurse Practitioner	Pediatrics	No
3	363LP0808X	Nurse Practitioner	Psychiatric/Mental Health	No
4	363LP2300X	Nurse Practitioner	Primary Care	No
5	363LW0102X	Nurse Practitioner	Women's Health	No
6	363LF0000X	Nurse Practitioner	Family	Yes

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 4/28/2024

NPI Synchronization or Removal

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