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25376 State Hwy 39 Suite 301 Shell Knob MO 65747 | |
(417) 269-2470 | |
(417) 858-6910 |
Full Name | |
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Speciality | Clinic/center - Rural Health |
Location | 25376 State Hwy 39, Shell Knob, Missouri |
Authorized Official Name and Position | David P. Taylor (VICE PRESIDENT) |
Authorized Official Contact | 4172696262 |
Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
Mailing Address | Practice Location Address |
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3800 S National Ave #540 Springfield MO 65807-5209 Ph: (417) 269-5712 | 25376 State Hwy 39 Suite 301 Shell Knob MO 65747 Ph: (417) 269-2470 |
NPI Number | 1144312497 |
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Provider Enumeration Date | 09/28/2006 |
Last Update Date | 06/10/2009 |
Identifier | Type | State | Issuer |
---|---|---|---|
1144312497 | NPI | - | NPPES |
595829706 | Medicaid | MO |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
207Q00000X | Family Medicine | (* (Not Available)) | Secondary |
261QR1300X | Clinic/center - Rural Health | (* (Not Available)) | Primary |