Full Name | |
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Speciality | Clinic/Center |
Location | 318 Sulphur St, Noel, Missouri |
Authorized Official Name and Position | Donald M Mcbride (CEO) |
Authorized Official Contact | 4174519450 |
Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
Mailing Address | Practice Location Address |
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Po Box 758 Neosho MO 64850-0758 Ph: (417) 437-8122 | 318 Sulphur St Noel MO 64854-9221 Ph: (417) 451-9450 |
NPI Number | 1598422461 |
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Provider Enumeration Date | 11/26/2021 |
Last Update Date | 11/04/2022 |
Medicare PECOS PAC ID | 8123918257 |
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Medicare Enrollment ID | O20220105000411 |
Identifier | Type | State | Issuer |
---|---|---|---|
1598422461 | NPI | - | NPPES |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
261QF0400X | Clinic/center - Federally Qualified Health Center (fqhc) | (* (Not Available)) | Primary |