Jack L Forest, DO | |
2016 S Main St, Maryville, MO 64468-2655 | |
(660) 562-2600 | |
(660) 562-7911 |
Full Name | Jack L Forest |
---|---|
Gender | Male |
Speciality | Surgery |
Location | 2016 S Main St, Maryville, Missouri |
Accepts Medicare Assignments | Medicare enrolled and may accept medicare through third-party reassignment. May prescribe medicare part D drugs. |
Identifier | Type | State | Issuer |
---|---|---|---|
1679560775 | NPI | - | NPPES |
C09633 | Other | VA | GROUP PTAN |
7313519 | Medicaid | VA | |
C06695 | Other | VA | GROUP PTAN |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
208600000X | Surgery | 049972 (Virginia) | Primary |
Entity Name | Fannin County Hospital Authority |
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Entity Type | Part A Provider - Critical Access Hospital |
Entity Identifiers | NPI Number: 1760417646 PECOS PAC ID: 6002054764 Enrollment ID: O20160920002262 |
Mailing Address | Practice Location Address |
---|---|
Jack L Forest, DO 114 E South Hills Dr, Maryville, MO 64468-2659 Ph: (660) 562-2600 | Jack L Forest, DO 2016 S Main St, Maryville, MO 64468-2655 Ph: (660) 562-2600 |
Dr. James E. Bradley, M.D. Surgery Medicare: Not Enrolled in Medicare Practice Location: 2016 S Main St, Maryville, MO 64468 Phone: 660-562-2525 Fax: 660-562-7993 | |
Shellie Kathleen Faris, MD Surgery Medicare: Accepting Medicare Assignments Practice Location: 2016 S Main St, Maryville, MO 64468 Phone: 660-562-2525 Fax: 660-562-4303 | |
Anthony Paul Melillo, Surgery Medicare: Not Enrolled in Medicare Practice Location: 2016 S Main St, Maryville, MO 64468 Phone: 660-562-2525 Fax: 660-562-7996 | |
Dr. Manuel W. Runez, M.D. Surgery Medicare: Not Enrolled in Medicare Practice Location: 2016 S Main St, Maryville, MO 64468 Phone: 660-562-2525 Fax: 660-562-7993 | |
Adon Harris, MD Surgery Medicare: Medicare Enrolled Practice Location: 2016 S Main St, Maryville, MO 64468 Phone: 660-562-7999 Fax: 660-562-7996 |