| |
289 Broadway St Neelyville MO 63954-7176 | |
(573) 663-2313 | |
Not Available |
Full Name | |
---|---|
Speciality | Clinic/Center |
Location | 289 Broadway St, Neelyville, Missouri |
Authorized Official Name and Position | Karen R White (CEO) |
Authorized Official Contact | 5736632313 |
Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
Mailing Address | Practice Location Address |
---|---|
110 S 2nd St Ellington MO 63638-9400 Ph: (573) 663-2313 | 289 Broadway St Neelyville MO 63954-7176 Ph: (573) 663-2313 |
NPI Number | 1417696774 |
---|---|
Provider Enumeration Date | 06/03/2022 |
Last Update Date | 06/20/2022 |
Medicare PECOS PAC ID | 6709871007 |
---|---|
Medicare Enrollment ID | O20220614001380 |
Identifier | Type | State | Issuer |
---|---|---|---|
1417696774 | NPI | - | NPPES |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
261QF0400X | Clinic/center - Federally Qualified Health Center (fqhc) | (* (Not Available)) | Primary |