Provider Demographics
NPI:1104106103
Name:I AM HEALTH CLINIC, LLC
Entity type:Organization
Organization Name:I AM HEALTH CLINIC, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:CHERI
Authorized Official - Middle Name:K
Authorized Official - Last Name:ALLISON
Authorized Official - Suffix:
Authorized Official - Credentials:FNP
Authorized Official - Phone:417-876-4771
Mailing Address - Street 1:1005 S ALLISON RD
Mailing Address - Street 2:SUITE A
Mailing Address - City:EL DORADO SPRINGS
Mailing Address - State:MO
Mailing Address - Zip Code:64744-2431
Mailing Address - Country:US
Mailing Address - Phone:417-876-4771
Mailing Address - Fax:417-876-4775
Practice Address - Street 1:1005 S ALLISON RD
Practice Address - Street 2:SUITE A
Practice Address - City:EL DORADO SPRINGS
Practice Address - State:MO
Practice Address - Zip Code:64744-2431
Practice Address - Country:US
Practice Address - Phone:417-876-4771
Practice Address - Fax:417-876-4775
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-08-22
Last Update Date:2011-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
No261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
No261QU0200XAmbulatory Health Care FacilitiesClinic/CenterUrgent Care