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600 W Morrison St Suite 5 Fayette MO 65248-1075 | |
(660) 248-2900 | |
(660) 248-1544 |
Full Name | |
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Speciality | Clinic/center - Rural Health |
Location | 600 W Morrison St, Fayette, Missouri |
Authorized Official Name and Position | Danielle Gearhart (ADMIN CEO) |
Authorized Official Contact | 6608827461 |
Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
Mailing Address | Practice Location Address |
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17651 B Hwy Boonville MO 65233-2839 Ph: (660) 882-7461 | 600 W Morrison St Suite 5 Fayette MO 65248-1075 Ph: (660) 248-2900 |
NPI Number | 1871626234 |
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Provider Enumeration Date | 03/14/2007 |
Last Update Date | 07/25/2014 |
Identifier | Type | State | Issuer |
---|---|---|---|
1871626234 | NPI | - | NPPES |
590328506 | Medicaid | MO | |
26-3483 | Other | MO | MEDICARE ID/OSCAR |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
261QR1300X | Clinic/center - Rural Health | (* (Not Available)) | Primary |