Impact Lifeline
Clinic/Center, Rural Health in Rolla, MO. Organization (NPI-2).
NPI number1467257576
StatusActive
Last updated in NPPESFeb 19, 2025
Details
- NPI
- 1467257576
- Entity type
- Organization (NPI-2)
- Legal business name
- Impact Lifeline
- Organization subpart
- No
- Enumeration date
- Feb 14, 2025
- Certification date
- Feb 19, 2025
- Last updated
- Feb 19, 2025
Taxonomy and licenses
| Taxonomy code | Description | License | State | Primary |
|---|---|---|---|---|
| 261QR1300X | Clinic/Center, Rural Health | – | – | Yes |
| 207Q00000X | Family Medicine | – | – | |
| 2083P0901X | Preventive Medicine, Public Health & General Preventive Medicine | – | – | |
| 251F00000X | Home Infusion | – | – | |
| 363LF0000X | Nurse Practitioner, Family | – | – |
Practice location
205 W 11th StRolla, MO 65401-2804
Phone 314-279-4565 · Fax 309-326-4526
Mailing address
8 Laurelwood CtSaint Louis, MO 63146-4940
Phone 314-279-4565 · Fax 309-326-4526
Other practice locations
13191 Rich Ln
Rolla, MO 65401-7546
Rolla, MO 65401-7546
Phone 314-279-4565
Authorized official
Alisha Michelle Jones
Executive Administrator
3142794565
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Other Rural Health Clinic/Center providers in Rolla, MO
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- Phelps County Regional Medical CenterNPI 1366066037
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All 6 Rural Health Clinic/Center providers in Rolla · All 863 providers in Rolla
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