| Dancing Horizon Health Foundation, Inc. | |
|
2400 Boonslick Drive Boonville MO 65233 | |
| (660) 882-9840 | |
| (660) 882-3504 |
| Full Name | Dancing Horizon Health Foundation, Inc. |
|---|---|
| Speciality | Clinic/center |
| Location | 2400 Boonslick Drive, Boonville, Missouri |
| Authorized Official Name and Position | Kevin W Louderback (MANAGING PARTNER) |
| Authorized Official Contact | 4174292180 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Dancing Horizon Health Foundation, Inc. Po Box 5111 Springfield MO 65802 Ph: (417) 429-2180 | Dancing Horizon Health Foundation, Inc. 2400 Boonslick Drive Boonville MO 65233 Ph: (660) 882-9840 |
| NPI Number | 1538181409 |
|---|---|
| Provider Enumeration Date | 07/23/2006 |
| Last Update Date | 07/18/2008 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1538181409 | NPI | - | NPPES |
| 202805958 | Medicaid | MO | |
| 501465009 | Medicaid | MO |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | RIF83 (Missouri) | Secondary |
| 261Q00000X | Clinic/center | (Missouri) | Primary |
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