| Full Name | |
|---|---|
| Speciality | Clinic/Center |
| Location | 611 Oak St, Lathrop, Missouri |
| Authorized Official Name and Position | John W Huddart (OWNER) |
| Authorized Official Contact | 8167404294 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
611 Oak St P.o. Box 79 Lathrop MO 64465-9737 Ph: (816) 740-4294 | 611 Oak St Lathrop MO 64465-9737 Ph: (816) 740-4294 |
| NPI Number | 1508148545 |
|---|---|
| Provider Enumeration Date | 09/15/2011 |
| Last Update Date | 09/15/2011 |
| Medicare PECOS PAC ID | 8022468636 |
|---|---|
| Medicare Enrollment ID | O20231222000582 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1508148545 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QD0000X | Clinic/center - Dental | 2001014206 (Missouri) | Primary |