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14762 W State Highway 90 Noel MO 64854-8108 | |
(417) 451-9450 | |
(417) 451-8903 |
Full Name | |
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Speciality | Clinic/Center |
Location | 14762 W State Highway 90, 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) 451-9450 | 14762 W State Highway 90 Noel MO 64854-8108 Ph: (417) 451-9450 |
NPI Number | 1922764216 |
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Provider Enumeration Date | 11/11/2021 |
Last Update Date | 03/20/2023 |
Medicare PECOS PAC ID | 8123918257 |
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Medicare Enrollment ID | O20220105000318 |
Identifier | Type | State | Issuer |
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1922764216 | NPI | - | NPPES |
Taxonomy | Type | License (State) | Status |
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261QF0400X | Clinic/center - Federally Qualified Health Center (fqhc) | (* (Not Available)) | Primary |