| Benton Medical Center | |
|
6724 Highway 77 E Benton MO 63736 | |
| (573) 545-4191 | |
| (573) 545-4425 |
| Full Name | Benton Medical Center |
|---|---|
| Speciality | Clinic/center - Federally Qualified Health Center (fqhc) |
| Location | 6724 Highway 77 E, Benton, Missouri |
| Authorized Official Name and Position | Chris Jones (CHIEF EXECUTIVE OFFICER) |
| Authorized Official Contact | 5737482404 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Benton Medical Center 420 Semo Dr New Madrid MO 63869-1734 Ph: (573) 748-2404 | Benton Medical Center 6724 Highway 77 E Benton MO 63736 Ph: (573) 545-4191 |
| NPI Number | 1528348778 |
|---|---|
| Provider Enumeration Date | 08/19/2011 |
| Last Update Date | 08/06/2014 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1528348778 | NPI | - | NPPES |
| 1497035661 | Medicaid | MO |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1223G0001X | Dentist - General Practice | (* (Not Available)) | Secondary |
| 261QF0400X | Clinic/center - Federally Qualified Health Center (fqhc) | (* (Not Available)) | Primary |