| Desoto Family Practice | |
|
12 Jefferson Sq Desoto MO 63020-1031 | |
| (636) 586-6685 | |
| (636) 586-2780 |
| Full Name | Desoto Family Practice |
|---|---|
| Speciality | Family Medicine |
| Location | 12 Jefferson Sq, Desoto, Missouri |
| Authorized Official Name and Position | Steven D Crawford (OWNER) |
| Authorized Official Contact | 6365866685 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Desoto Family Practice 12 Jefferson Sq Desoto MO 63020-1031 Ph: (636) 586-6685 | Desoto Family Practice 12 Jefferson Sq Desoto MO 63020-1031 Ph: (636) 586-6685 |
| NPI Number | 1588719413 |
|---|---|
| Provider Enumeration Date | 01/23/2007 |
| Last Update Date | 03/07/2023 |
| Medicare PECOS PAC ID | 5991763401 |
|---|---|
| Medicare Enrollment ID | O20041230000395 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1588719413 | NPI | - | NPPES |
| 41506 | Other | MO | AOA # |
| 598201408 | Medicaid | MO |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | R6C68 (Missouri) | Primary |
| 207Q00000X | Family Medicine | 2002007109 (Maryland) | Secondary |
Midwest Medical Practitioners Llc Primary Care Clinic Medicare: Medicare Enrolled Practice Location: 120 Boyd St, Desoto, MO 63020 Phone: 636-282-0380 Fax: 877-592-0806 |