| Bootheel Outpatient Clinic | |
|
215 S 3rd St Hayti MO 63851-1617 | |
| (573) 922-7383 | |
| Not Available |
| Full Name | Bootheel Outpatient Clinic |
|---|---|
| Speciality | Psychiatry & Neurology |
| Location | 215 S 3rd St, Hayti, Missouri |
| Authorized Official Name and Position | Lara Huffman (CEO) |
| Authorized Official Contact | 5739227383 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Bootheel Outpatient Clinic 215 S 3rd St Hayti MO 63851-1617 Ph: (573) 922-7383 | Bootheel Outpatient Clinic 215 S 3rd St Hayti MO 63851-1617 Ph: (573) 922-7383 |
| NPI Number | 1255974143 |
|---|---|
| Provider Enumeration Date | 10/23/2019 |
| Last Update Date | 01/16/2020 |
| Certification Date | 01/16/2020 |
| Medicare PECOS PAC ID | 2961834916 |
|---|---|
| Medicare Enrollment ID | O20191113003064 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1255974143 | NPI | - | NPPES |
| Provider Name | Ladonna J Williams |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1861826968 PECOS PAC ID: 9739319757 Enrollment ID: I20140312001832 |
| Provider Name | Lara Huffman |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1013987510 PECOS PAC ID: 3971785262 Enrollment ID: I20150306002047 |
Pemiscot County Memorial Hospital Mental Health Clinic Medicare: Medicare Enrolled Practice Location: 946 E Reed St, Hayti, MO 63851 Phone: 573-359-1372 Fax: 573-359-3601 | |
Pemiscot County Memorial Hospital Mental Health Clinic Medicare: Medicare Enrolled Practice Location: 946 E Reed St, Hayti, MO 63851 Phone: 573-359-1372 Fax: 573-359-3601 |