Provider Demographics
NPI:1851420525
Name:ELK RIVER HEALTH SERVICES, INC.
Entity type:Organization
Organization Name:ELK RIVER HEALTH SERVICES, INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR OF CLINICS
Authorized Official - Prefix:
Authorized Official - First Name:VICKI
Authorized Official - Middle Name:
Authorized Official - Last Name:PLUMLEE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:417-223-4290
Mailing Address - Street 1:PO BOX 265
Mailing Address - Street 2:
Mailing Address - City:PINEVILLE
Mailing Address - State:MO
Mailing Address - Zip Code:64856-0265
Mailing Address - Country:US
Mailing Address - Phone:417-223-4290
Mailing Address - Fax:417-223-4299
Practice Address - Street 1:5265 S BUS HWY 71
Practice Address - Street 2:SUITE J
Practice Address - City:PINEVILLE
Practice Address - State:MO
Practice Address - Zip Code:64856-0265
Practice Address - Country:US
Practice Address - Phone:417-223-4290
Practice Address - Fax:417-223-4299
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-05
Last Update Date:2014-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO506813807Medicaid
MO000013506Medicare ID - Type UnspecifiedMEDICARE NON RHC NUMBER