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3650 Stardust Dr Hannibal MO 63401-2480 | |
(573) 231-0660 | |
(573) 231-0687 |
Full Name | |
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Speciality | Clinic/Center |
Location | 3650 Stardust Dr, Hannibal, Missouri |
Authorized Official Name and Position | Robert Gasaway (CFO) |
Authorized Official Contact | 5734061609 |
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 801222 Kansas City MO 64180-1222 Ph: (573) 248-5672 | 3650 Stardust Dr Hannibal MO 63401-2480 Ph: (573) 231-0660 |
NPI Number | 1083154991 |
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Provider Enumeration Date | 02/27/2017 |
Last Update Date | 02/27/2017 |
Medicare PECOS PAC ID | 1254236300 |
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Medicare Enrollment ID | O20170711002093 |
Identifier | Type | State | Issuer |
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1083154991 | NPI | - | NPPES |
Taxonomy | Type | License (State) | Status |
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261QR1300X | Clinic/center - Rural Health | (* (Not Available)) | Primary |
Marion County Health Dept. & Home Health Agency Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 3105 Rt. W, Hannibal, MO 63401 Phone: 573-221-1166 Fax: 573-221-1214 | |