Full Name | |
---|---|
Speciality | Clinic/Center |
Location | 29 Nw 1st Ln, Lamar, Missouri |
Authorized Official Name and Position | Jeffrey Hawkins (VICE PRESIDENT OF OPERATIONS) |
Authorized Official Contact | 4172696263 |
Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
Mailing Address | Practice Location Address |
---|---|
Po Box 505673 Saint Louis MO 63150-5673 Ph: () - | 29 Nw 1st Ln Lamar MO 64759-8105 Ph: (417) 681-5284 |
NPI Number | 1255847745 |
---|---|
Provider Enumeration Date | 12/19/2017 |
Last Update Date | 09/30/2024 |
Medicare PECOS PAC ID | 8820329782 |
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Medicare Enrollment ID | O20200306000220 |
Identifier | Type | State | Issuer |
---|---|---|---|
1255847745 | NPI | - | NPPES |
268648 | Other | MO | PTAN |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
207Q00000X | Family Medicine | (* (Not Available)) | Secondary |
261QR1300X | Clinic/center - Rural Health | (* (Not Available)) | Primary |
C. Tucker Joustra Family Practice, Inc. Primary Care Clinic Medicare: Medicare Enrolled Practice Location: 805 Gulf St, Lamar, MO 64759 Phone: 417-682-5508 Fax: 417-682-5594 | |
Alden Medical Clinic, Llc Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 210 W 10th St, Lamar, MO 64759 Phone: 417-682-5123 Fax: 417-682-3445 |