| C. Tucker Joustra Family Practice, Inc. | |
|
805 Gulf St Lamar MO 64759-1238 | |
| (417) 682-5508 | |
| (417) 682-5594 |
| Full Name | C. Tucker Joustra Family Practice, Inc. |
|---|---|
| Speciality | Clinic/Center |
| Location | 805 Gulf St, Lamar, Missouri |
| Authorized Official Name and Position | Clarence Tucker Joustra (PRESIDENT) |
| Authorized Official Contact | 4176825508 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| C. Tucker Joustra Family Practice, Inc. 805 Gulf St Lamar MO 64759-1238 Ph: (417) 682-5508 | C. Tucker Joustra Family Practice, Inc. 805 Gulf St Lamar MO 64759-1238 Ph: (417) 682-5508 |
| NPI Number | 1609108240 |
|---|---|
| Provider Enumeration Date | 02/08/2010 |
| Last Update Date | 02/08/2010 |
| Medicare PECOS PAC ID | 4284779398 |
|---|---|
| Medicare Enrollment ID | O20100301000432 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1609108240 | NPI | - | NPPES |
| 242426534 | Medicaid | MO |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QP2300X | Clinic/center - Primary Care | R9G86 (Missouri) | Primary |
| Provider Name | Kristin C Robertson |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1003949587 PECOS PAC ID: 3274630694 Enrollment ID: I20070521000097 |
| Provider Name | Clarence T Joustra |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1942202080 PECOS PAC ID: 5193782472 Enrollment ID: I20100301000424 |
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