| Big Tree Medical Home | |
|
200 Corporate Lake Dr Columbia MO 65203-7172 | |
| (573) 814-1170 | |
| Not Available |
| Full Name | Big Tree Medical Home |
|---|---|
| Speciality | Family Medicine |
| Location | 200 Corporate Lake Dr, Columbia, Missouri |
| Authorized Official Name and Position | Adam Wheeler (CEO) |
| Authorized Official Contact | 5736735770 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Big Tree Medical Home 200 Corporate Lake Dr Columbia MO 65203-7172 Ph: (573) 814-1170 | Big Tree Medical Home 200 Corporate Lake Dr Columbia MO 65203-7172 Ph: (573) 814-1170 |
| NPI Number | 1740858562 |
|---|---|
| Provider Enumeration Date | 06/17/2021 |
| Last Update Date | 01/04/2023 |
| Certification Date | 01/04/2023 |
| Medicare PECOS PAC ID | 6507232543 |
|---|---|
| Medicare Enrollment ID | O20221017002513 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1740858562 | NPI | - | NPPES |
| Provider Name | Adam D Wheeler |
|---|---|
| Provider Type | Practitioner - Pediatric Medicine |
| Provider Identifiers | NPI Number: 1891803086 PECOS PAC ID: 5395802318 Enrollment ID: I20090318000646 |
| Provider Name | Sarah Lynne Calhoun |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1952404949 PECOS PAC ID: 5799831475 Enrollment ID: I20090922000335 |
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