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151 Johnstown Drive Rogersville MO 65742-9366 | |
(417) 269-2252 | |
(417) 269-2259 |
Full Name | |
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Speciality | Clinic/Center |
Location | 151 Johnstown Drive, Rogersville, Missouri |
Authorized Official Name and Position | Jacob Mcway (SR VP & CFO) |
Authorized Official Contact | 4172698811 |
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 | 151 Johnstown Drive Rogersville MO 65742-9366 Ph: (417) 269-2252 |
NPI Number | 1164456612 |
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Provider Enumeration Date | 07/10/2006 |
Last Update Date | 09/27/2024 |
Medicare PECOS PAC ID | 1254248917 |
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Medicare Enrollment ID | O20030721000005 |
Identifier | Type | State | Issuer |
---|---|---|---|
1164456612 | NPI | - | NPPES |
596059006 | Medicaid | MO |
Taxonomy | Type | License (State) | Status |
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207Q00000X | Family Medicine | (* (Not Available)) | Secondary |
261QR1300X | Clinic/center - Rural Health | (* (Not Available)) | Primary |