Full Name | |
---|---|
Speciality | Clinic/Center |
Location | 709 E Pine St., Archie, Missouri |
Authorized Official Name and Position | Janie Elliott (BUSINESS OFFICE MANAGER) |
Authorized Official Contact | 8168870315 |
Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
Mailing Address | Practice Location Address |
---|---|
2800 E Rock Haven Rd Harrisonville MO 64701-4411 Ph: (816) 887-0315 | 709 E Pine St. Archie MO 64725 Ph: (816) 430-5777 |
NPI Number | 1760472922 |
---|---|
Provider Enumeration Date | 10/27/2005 |
Last Update Date | 11/01/2022 |
Medicare PECOS PAC ID | 7517853781 |
---|---|
Medicare Enrollment ID | O20040928001113 |
Identifier | Type | State | Issuer |
---|---|---|---|
1760472922 | NPI | - | NPPES |
593863004 | Medicaid | MO | |
24824010 | Other | MO | BCBS OF KC |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
261QR1300X | Clinic/center - Rural Health | (* (Not Available)) | Primary |