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10763 Highway 39 Suite 200 Mount Vernon MO 65712-7823 | |
(417) 269-2460 | |
(417) 269-2462 |
Full Name | |
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Speciality | Clinic/center - Rural Health |
Location | 10763 Highway 39, Mount Vernon, Missouri |
Authorized Official Name and Position | David P Taylor (VICE PRESIDENT) |
Authorized Official Contact | 4174662875 |
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 65807-5284 Ph: (417) 269-5712 | 10763 Highway 39 Suite 200 Mount Vernon MO 65712-7823 Ph: (417) 269-2460 |
NPI Number | 1780778449 |
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Provider Enumeration Date | 10/03/2006 |
Last Update Date | 01/06/2014 |
Identifier | Type | State | Issuer |
---|---|---|---|
1780778449 | NPI | - | NPPES |
116760 | Other | BLUE CROSS OF MO | |
508603909 | Medicaid | MO | |
598603900 | Medicaid | MO |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
207Q00000X | Family Medicine | (* (Not Available)) | Secondary |
261QR1300X | Clinic/center - Rural Health | (* (Not Available)) | Primary |
Oncare Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 918 Sunshine Dr, Mount Vernon, MO 65712 Phone: 417-553-9583 Fax: 417-553-9585 | |