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405 Center St. Suite 1 Bismarck MO 63624 | |
(573) 854-2273 | |
(573) 200-8033 |
Full Name | |
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Speciality | Clinic/Center |
Location | 405 Center St., Bismarck, Missouri |
Authorized Official Name and Position | Kimberly I Weiss (PROVIDER) |
Authorized Official Contact | 5732008030 |
Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
Mailing Address | Practice Location Address |
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405 Center St. Bismarck MO 63624 Ph: (573) 200-8030 | 405 Center St. Suite 1 Bismarck MO 63624 Ph: (573) 854-2273 |
NPI Number | 1366161945 |
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Provider Enumeration Date | 08/25/2022 |
Last Update Date | 01/04/2024 |
Medicare PECOS PAC ID | 0547645434 |
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Medicare Enrollment ID | O20220913001863 |
Identifier | Type | State | Issuer |
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1366161945 | NPI | - | NPPES |
Provider Name | Kimberly Irene Weiss |
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Provider Type | Practitioner - Nurse Practitioner |
Provider Identifiers | NPI Number: 1073268488 PECOS PAC ID: 0941687081 Enrollment ID: I20220511001862 |