| Pomme De Terre Wellness Clinic | |
|
900 E San Martin St Bolivar MO 65613-2893 | |
| (417) 326-7272 | |
| (417) 326-2193 |
| Full Name | Pomme De Terre Wellness Clinic |
|---|---|
| Speciality | Clinic/Center |
| Location | 900 E San Martin St, Bolivar, Missouri |
| Authorized Official Name and Position | Denese Strange (OFFICE MANAGER) |
| Authorized Official Contact | 4173267272 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Pomme De Terre Wellness Clinic Po Box 49 Bolivar MO 65613-0049 Ph: (417) 326-7272 | Pomme De Terre Wellness Clinic 900 E San Martin St Bolivar MO 65613-2893 Ph: (417) 326-7272 |
| NPI Number | 1417902305 |
|---|---|
| Provider Enumeration Date | 05/23/2006 |
| Last Update Date | 07/10/2024 |
| Certification Date | 07/10/2024 |
| Medicare PECOS PAC ID | 7012979974 |
|---|---|
| Medicare Enrollment ID | O20050103000556 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1417902305 | NPI | - | NPPES |
| 597191808 | Medicaid | MO |
| Provider Name | Tommie L Miller |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1255395380 PECOS PAC ID: 7012975352 Enrollment ID: I20050418000169 |
| Provider Name | John Howell |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1629032727 PECOS PAC ID: 2365404225 Enrollment ID: I20050512000328 |
| Provider Name | Angela Olomon |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1487618062 PECOS PAC ID: 1456313311 Enrollment ID: I20050512000429 |
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