Basic Information
| Provider Information | |||||||||
| NPI: | 1427572007 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | MISSOURI DELTA MEDICAL CENTER | ||||||||
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| OtherOrganizationName: | CHAFFEE MEDICAL CLINIC | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1008 N MAIN ST | ||||||||
| Address2: | |||||||||
| City: | SIKESTON | ||||||||
| State: | MO | ||||||||
| PostalCode: | 638015044 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5734727406 | ||||||||
| FaxNumber: | 5734727475 | ||||||||
| Practice Location | |||||||||
| Address1: | 209 W YOAKUM AVE | ||||||||
| Address2: | |||||||||
| City: | CHAFFEE | ||||||||
| State: | MO | ||||||||
| PostalCode: | 637401138 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5738874171 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 07/26/2017 | ||||||||
| LastUpdateDate: | 07/26/2017 | ||||||||
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| AuthorizedOfficialLastName: | SCHRUMPF | ||||||||
| AuthorizedOfficialFirstName: | JASON | ||||||||
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| AuthorizedOfficialTitleorPosition: | CEO | ||||||||
| AuthorizedOfficialTelephone: | 5734727601 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 261QR1300X | Y | Ambulatory Health Care Facilities | Clinic/Center | Rural Health |
No ID Information.