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503 S 6th St Saint Joseph MO 64501-2224 | |
(816) 233-5188 | |
Not Available |
Full Name | |
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Speciality | Clinic/Center |
Location | 503 S 6th St, Saint Joseph, Missouri |
Authorized Official Name and Position | Matt Younger (CEO) |
Authorized Official Contact | 8162326818 |
Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
Mailing Address | Practice Location Address |
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2303 Village Dr Saint Joseph MO 64506-4954 Ph: (816) 271-8219 | 503 S 6th St Saint Joseph MO 64501-2224 Ph: (816) 233-5188 |
NPI Number | 1861646168 |
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Provider Enumeration Date | 11/13/2008 |
Last Update Date | 11/10/2021 |
Medicare PECOS PAC ID | 7113835174 |
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Medicare Enrollment ID | O20090102000423 |
Identifier | Type | State | Issuer |
---|---|---|---|
1861646168 | NPI | - | NPPES |
261031 | Other | MO | FQHC FACILITY NUMBER |
F290000A | Other | MEDICARE PART B ID |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
207Q00000X | Family Medicine | (* (Not Available)) | Secondary |
261QF0400X | Clinic/center - Federally Qualified Health Center (fqhc) | (Missouri) | Primary |