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200 St. Mary Pilot Knob MO 63663-0523 | |
(573) 546-7000 | |
(573) 546-6420 |
Full Name | |
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Speciality | Clinic/center - Rural Health |
Location | 200 St. Mary, Pilot Knob, Missouri |
Authorized Official Name and Position | Lisa Marie Twidwell (CEO) |
Authorized Official Contact | 5737833341 |
Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
Mailing Address | Practice Location Address |
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200 St. Mary P O Box 523 Pilot Knob MO 63663-0523 Ph: (573) 546-7000 | 200 St. Mary Pilot Knob MO 63663-0523 Ph: (573) 546-7000 |
NPI Number | 1649357229 |
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Provider Enumeration Date | 11/01/2006 |
Last Update Date | 12/18/2013 |
Identifier | Type | State | Issuer |
---|---|---|---|
1649357229 | NPI | - | NPPES |
595679408 | Medicaid | MO |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
261QR1300X | Clinic/center - Rural Health | (* (Not Available)) | Primary |
Boonyasai & Boonyasai, M.d.p. C. Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 200 St . Marys Street, Lower Level, Pilot Knob, MO 63663 Phone: 573-546-3929 Fax: 573-546-3962 | |