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1602 N Main St Ste A Mountain Grove MO 65711-1010 | |
(417) 269-4268 | |
(417) 269-3104 |
Full Name | |
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Speciality | Family Medicine |
Location | 1602 N Main St Ste A, Mountain Grove, Missouri |
Authorized Official Name and Position | Jacob Mcway (SENIOR VP & CFO) |
Authorized Official Contact | 4172698811 |
Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
Mailing Address | Practice Location Address |
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3800 S National Ave Ste 540 Springfield MO 65807-5284 Ph: (417) 269-5712 | 1602 N Main St Ste A Mountain Grove MO 65711-1010 Ph: (417) 269-4268 |
NPI Number | 1891214003 |
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Provider Enumeration Date | 09/19/2017 |
Last Update Date | 09/19/2017 |
Identifier | Type | State | Issuer |
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1891214003 | NPI | - | NPPES |
Taxonomy | Type | License (State) | Status |
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207Q00000X | Family Medicine | (* (Not Available)) | Primary |
Mountain Grove Medical And Laser Center Inc Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 601 N Busch Ave, Mountain Grove, MO 65711 Phone: 417-926-6643 Fax: 417-926-6317 | |