Provider Demographics
NPI:1538167333
Name:JMH DIVISIFIED HEALTHCARE
Entity type:Organization
Organization Name:JMH DIVISIFIED HEALTHCARE
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:DENNIS
Authorized Official - Middle Name:PATRICK
Authorized Official - Last Name:HALLEY
Authorized Official - Suffix:
Authorized Official - Credentials:MSA
Authorized Official - Phone:636-933-1178
Mailing Address - Street 1:PO BOX 279
Mailing Address - Street 2:
Mailing Address - City:FESTUS
Mailing Address - State:MO
Mailing Address - Zip Code:63028-0279
Mailing Address - Country:US
Mailing Address - Phone:636-933-5730
Mailing Address - Fax:636-933-5301
Practice Address - Street 1:1400 HIGHWAY 61
Practice Address - Street 2:
Practice Address - City:FESTUS
Practice Address - State:MO
Practice Address - Zip Code:63028-4100
Practice Address - Country:US
Practice Address - Phone:636-933-5730
Practice Address - Fax:636-933-5301
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-07-14
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO0991213416L0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO81 81285OtherMEDICARE COMPLETE
MO122373OtherBLUE CHOICE
MO1033804OtherCARE PARTNERS
MO8229OtherHEALTH CARE USA
MO122373OtherBLUE CROSS BLUE SHIELD
MO241762OtherHEALTHLINK
MO3329921OtherHEALTH MARKET