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304 W Washington Ave Richland MO 65556-7101 | |
(573) 765-5131 | |
(573) 765-3122 |
Full Name | |
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Speciality | Clinic/Center |
Location | 304 W Washington Ave, Richland, 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 | 304 W Washington Ave Richland MO 65556-7101 Ph: (573) 765-5131 |
NPI Number | 1245361344 |
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Provider Enumeration Date | 03/08/2007 |
Last Update Date | 08/11/2021 |
Medicare PECOS PAC ID | 2062554025 |
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Medicare Enrollment ID | O20100914000709 |
Identifier | Type | State | Issuer |
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1245361344 | NPI | - | NPPES |
501616718 | Medicaid | MO |
Taxonomy | Type | License (State) | Status |
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261QF0400X | Clinic/center - Federally Qualified Health Center (fqhc) | (* (Not Available)) | Primary |