Calvary Medical Center, Llc | |
450 New Creation Road North Newark MO 63458-9744 | |
(660) 284-4300 | |
(660) 284-4339 |
Full Name | Calvary Medical Center, Llc |
---|---|
Speciality | Family Medicine |
Location | 450 New Creation Road North, Newark, Missouri |
Authorized Official Name and Position | Wendell A Nickerson (OWNER) |
Authorized Official Contact | 6602844300 |
Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
Mailing Address | Practice Location Address |
---|---|
Calvary Medical Center, Llc 450 New Creation Road North Newark MO 63458-9744 Ph: () - | Calvary Medical Center, Llc 450 New Creation Road North Newark MO 63458-9744 Ph: (660) 284-4300 |
NPI Number | 1528263464 |
---|---|
Provider Enumeration Date | 06/20/2007 |
Last Update Date | 11/09/2010 |
Identifier | Type | State | Issuer |
---|---|---|---|
1528263464 | NPI | - | NPPES |
509038808 | Medicaid | MO |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
207Q00000X | Family Medicine | R9345 (Missouri) | Primary |