Organization · Type 2 NPI
Impact Lifeline
Rural Health Clinic/Center · Rolla, MO
NPI number
1467257576
Active
Practice location
205 W 11th St
Rolla, MO 65401-2804
Fax (309) 326-4526
Mailing address
8 Laurelwood Ct
St. Louis, MO 63146-4940
Other practice locations
- 13191 Rich Ln, Rolla, MO 65401-7546 · (314) 279-4565
Specialties and licenses
| Taxonomy | Code | License |
|---|---|---|
| Family Medicine Physician | 207Q00000X | None listed |
| Public Health & General Preventive Medicine Physician | 2083P0901X | None listed |
| Home Infusion Agency | 251F00000X | None listed |
| Rural Health Clinic/Center Primary | 261QR1300X | None listed |
| Family Nurse Practitioner | 363LF0000X | None listed |
Rural Health Clinic/Center: Definition to come...
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About NPI 1467257576
Impact Lifeline's National Provider Identifier is 1467257576, issued on Feb 14, 2025. The primary taxonomy on file is Rural Health Clinic/Center (261QR1300X), and the practice location is in Rolla, MO. The record was last updated on Feb 19, 2025.