| Jefferson City Outpatient Clinic | |
|
204 Metro Dr Suite B Jefferson City MO 65109-4408 | |
| (573) 634-4591 | |
| (573) 634-4792 |
| Full Name | Jefferson City Outpatient Clinic |
|---|---|
| Speciality | Clinic/center |
| Location | 204 Metro Dr, Jefferson City, 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 |
|---|---|
| Jefferson City Outpatient Clinic 117 N Garth Ave Columbia MO 65203-4103 Ph: (573) 443-2204 | Jefferson City Outpatient Clinic 204 Metro Dr Suite B Jefferson City MO 65109-4408 Ph: (573) 634-4591 |
| NPI Number | 1467597872 |
|---|---|
| Provider Enumeration Date | 02/21/2007 |
| Last Update Date | 08/22/2020 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1467597872 | 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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