| Cherry Hill Clinic | |
|
1160 E High Point Ln Columbia MO 65203-9335 | |
| (352) 226-7603 | |
| Not Available |
| Full Name | Cherry Hill Clinic |
|---|---|
| Speciality | Family Medicine |
| Location | 1160 E High Point Ln, Columbia, Missouri |
| Authorized Official Name and Position | Ellen Dukate (CREDENTIALING SPECIALIST) |
| Authorized Official Contact | 9045152625 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Cherry Hill Clinic 1160 E High Point Ln Columbia MO 65203-9335 Ph: () - | Cherry Hill Clinic 1160 E High Point Ln Columbia MO 65203-9335 Ph: (352) 226-7603 |
| NPI Number | 1780193920 |
|---|---|
| Provider Enumeration Date | 09/20/2017 |
| Last Update Date | 09/20/2017 |
| Medicare PECOS PAC ID | 9739440702 |
|---|---|
| Medicare Enrollment ID | O20180308000805 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1780193920 | NPI | - | NPPES |
| 2011003501 | Other | MO | MD LICENSE |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | (* (Not Available)) | Primary |
| Provider Name | Sheena Jose |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1710055389 PECOS PAC ID: 6507998424 Enrollment ID: I20110322000776 |
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