| Fulton Outpatient Clinic | |
|
2625 Fairway Dr Fulton MO 65251-3936 | |
| (573) 642-3239 | |
| (573) 642-3239 |
| Full Name | Fulton Outpatient Clinic |
|---|---|
| Speciality | Clinic/center |
| Location | 2625 Fairway Dr, Fulton, 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 |
|---|---|
| Fulton Outpatient Clinic 117 N Garth Ave Columbia MO 65203-4103 Ph: (573) 443-2204 | Fulton Outpatient Clinic 2625 Fairway Dr Fulton MO 65251-3936 Ph: (573) 642-3239 |
| NPI Number | 1558406959 |
|---|---|
| Provider Enumeration Date | 02/21/2007 |
| Last Update Date | 08/22/2020 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1558406959 | 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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