Full Name | |
---|---|
Speciality | Clinic/Center |
Location | 112 S Pine St, Eldon, Missouri |
Authorized Official Name and Position | Kelly Miller (CEO) |
Authorized Official Contact | 5738367071 |
Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
Mailing Address | Practice Location Address |
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Po Box 777 Richland MO 65556-0777 Ph: (573) 765-5131 | 112 S Pine St Eldon MO 65026-1581 Ph: (573) 765-5131 |
NPI Number | 1215436522 |
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Provider Enumeration Date | 02/02/2018 |
Last Update Date | 02/03/2022 |
Medicare PECOS PAC ID | 2062554025 |
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Medicare Enrollment ID | O20220217001880 |
Identifier | Type | State | Issuer |
---|---|---|---|
1215436522 | NPI | - | NPPES |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
261QF0400X | Clinic/center - Federally Qualified Health Center (fqhc) | (* (Not Available)) | Primary |
Malcolm J. Dickerson, M.d., P.c. Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 411 W 4th St, Eldon, MO 65026 Phone: 573-392-9200 Fax: 573-392-4626 | |
Eldon Family Chiropractic, Llc Primary Care Clinic Medicare: Medicare Enrolled Practice Location: 102 N Business Highway 54 E Ste D, Eldon, MO 65026 Phone: 573-286-2638 | |