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304 E Jackson St #b-207 Willard MO 65781-9333 | |
(417) 269-2458 | |
(417) 269-2465 |
Full Name | |
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Speciality | Family Medicine |
Location | 304 E Jackson St, Willard, 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) 269-6262 | 304 E Jackson St #b-207 Willard MO 65781-9333 Ph: (417) 269-2458 |
NPI Number | 1356429286 |
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Provider Enumeration Date | 11/01/2006 |
Last Update Date | 06/20/2008 |
Identifier | Type | State | Issuer |
---|---|---|---|
1356429286 | NPI | - | NPPES |
506215300 | Medicaid | MO |
Taxonomy | Type | License (State) | Status |
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207Q00000X | Family Medicine | (* (Not Available)) | Primary |