| Mindsmattersmd Llc | |
|
3322 S Campbell Ave Ste T-10 Springfield MO 65807-4980 | |
| (313) 506-3036 | |
| (844) 476-6600 |
| Full Name | Mindsmattersmd Llc |
|---|---|
| Speciality | Psychiatry & Neurology |
| Location | 3322 S Campbell Ave Ste T-10, Springfield, Missouri |
| Authorized Official Name and Position | Osamede Edokpolo (OWNER/MEDICAL DIRECTOR) |
| Authorized Official Contact | 3135063036 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Mindsmattersmd Llc 3322 S Campbell Ave Ste T-10 Springfield MO 65807-4980 Ph: (313) 506-3036 | Mindsmattersmd Llc 3322 S Campbell Ave Ste T-10 Springfield MO 65807-4980 Ph: (313) 506-3036 |
| NPI Number | 1356962799 |
|---|---|
| Provider Enumeration Date | 04/27/2020 |
| Last Update Date | 04/19/2022 |
| Certification Date | 02/01/2022 |
| Medicare PECOS PAC ID | 3971912932 |
|---|---|
| Medicare Enrollment ID | O20210504002898 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1356962799 | NPI | - | NPPES |
| 1326334459 | Medicaid | MO |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 2084N0400X | Psychiatry & Neurology - Neurology | (* (Not Available)) | Primary |
| Provider Name | Osamede Edokpolo |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1326334459 PECOS PAC ID: 2062655723 Enrollment ID: I20130827000958 |
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