| Boonville Outpatient Clinic | |
|
15899 Logans Lake Rd #a Boonville MO 65233-2866 | |
| (660) 882-2333 | |
| (660) 882-2333 |
| Full Name | Boonville Outpatient Clinic |
|---|---|
| Speciality | Clinic/center |
| Location | 15899 Logans Lake Rd, Boonville, Missouri |
| Authorized Official Name and Position | Allen Tacker (EXECUTIVE DIRECTOR) |
| Authorized Official Contact | 5734432204 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Boonville Outpatient Clinic 117 N Garth Ave Columbia MO 65203-4103 Ph: (573) 443-2204 | Boonville Outpatient Clinic 15899 Logans Lake Rd #a Boonville MO 65233-2866 Ph: (660) 882-2333 |
| NPI Number | 1538204904 |
|---|---|
| Provider Enumeration Date | 02/21/2007 |
| Last Update Date | 08/22/2020 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1538204904 | NPI | - | NPPES |
| 1649269622 | Other | MO | FCCMO BILLING NPI NUMBER |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 101Y00000X | Counselor | (* (Not Available)) | Primary |
| 261Q00000X | Clinic/center | (* (Not Available)) | Primary |
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