Full Name | |
---|---|
Speciality | Family Medicine |
Location | 806 Sw 13th Ave, Ava, Missouri |
Authorized Official Name and Position | David P. Taylor (VICE PRESIDENT) |
Authorized Official Contact | 4172696262 |
Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
Mailing Address | Practice Location Address |
---|---|
3800 S National Ave #540 Springfield MO 65807-5209 Ph: (417) 269-6262 | 806 Sw 13th Ave Ava MO 65608 Ph: (417) 683-7200 |
NPI Number | 1942390695 |
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Provider Enumeration Date | 10/13/2006 |
Last Update Date | 09/02/2008 |
Identifier | Type | State | Issuer |
---|---|---|---|
1942390695 | NPI | - | NPPES |
505978502 | Medicaid | MO | |
116756 | Other | BLUE CROSS OF MO |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
207Q00000X | Family Medicine | (* (Not Available)) | Primary |
Douglas County Health Department Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 603 Nw 12th St, Building C, Ava, MO 65608 Phone: 417-683-4174 Fax: 417-683-4111 | |