Bonne Terre Health Clinic LLC
NPI #1104071935 in Bonne Terre, Missouri
Provider Information
- NPI Number
- 1104071935
- Entity Type
- Organization
- Organization Name
- Bonne Terre Health Clinic LLC
- Primary Specialty
- Clinic/Center - Rural Health
- Enumeration Date
- Nov 20, 2008
- Last Updated
- Sep 24, 2009
Practice Location
- Address
- 55 NESBIT DR
- City
- Bonne Terre
- State
- Missouri
- ZIP Code
- 63628-1353
- Phone
- (573) 358-3343
Authorized Official
- Name
- MR. ANDREW JOHN NINICHUCK, M.D.
- Title
- MEMBER
- Phone
- (573) 358-3343
Specialties & Taxonomy Codes
| Specialty |
|---|
| Family Medicine |
| Clinic/Center - Rural Health — Rural Health |
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