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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 |
Location | 10763 Highway 39, Mount Vernon, Missouri |
Authorized Official Name and Position | Jeffrey Hawkins (VP OF OPERATIONS) |
Authorized Official Contact | 4172696263 |
Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
Mailing Address | Practice Location Address |
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Po Box 505673 Saint Louis MO 63150-5673 Ph: (417) 730-6430 | 10763 Highway 39 Suite 200 Mount Vernon MO 65712-7823 Ph: (417) 269-2460 |
NPI Number | 1912366329 |
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Provider Enumeration Date | 02/12/2016 |
Last Update Date | 09/30/2024 |
Medicare PECOS PAC ID | 0345236667 |
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Medicare Enrollment ID | O20160304001747 |
Identifier | Type | State | Issuer |
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1912366329 | NPI | - | NPPES |
Taxonomy | Type | License (State) | Status |
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207Q00000X | Family Medicine | (* (Not Available)) | Secondary |
261QR1300X | Clinic/center - Rural Health | (Missouri) | 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 | |