| |
220 South Woodbine Rd Saint Joseph MO 64506 | |
(816) 676-1300 | |
(816) 676-1400 |
Full Name | |
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Speciality | Family Medicine |
Location | 220 South Woodbine Rd, Saint Joseph, Missouri |
Authorized Official Name and Position | Patricia Ann Buckles (OFFICE MANAGER) |
Authorized Official Contact | 8166761300 |
Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
Mailing Address | Practice Location Address |
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220 South Woodbine Rd Saint Joseph MO 64506 Ph: (816) 676-1300 | 220 South Woodbine Rd Saint Joseph MO 64506 Ph: (816) 676-1300 |
NPI Number | 1396753422 |
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Provider Enumeration Date | 08/04/2006 |
Last Update Date | 12/29/2009 |
Medicare PECOS PAC ID | 7618916446 |
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Medicare Enrollment ID | O20050429000857 |
Identifier | Type | State | Issuer |
---|---|---|---|
1396753422 | NPI | - | NPPES |
458858 | Other | MO | FREEDOM/HEALTHLINK ID |
10001359400 | Other | MO | CHP ID |
27020012 | Other | MO | BCKC GRP ID |
458828 | Other | MO | HEALTHLINK GRP ID |
CH5327 | Other | MO | RAILROAD RETIREMENT BOARD |
10001359400 | Other | MO | COMMUNITY HEALTH PLAN |
2326850 | Other | MO | AETNA PROV ID |
499640064 | Other | MO | WPS/WEST REG. CLAIMS ID |
505804906 | Medicaid | MO |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
207Q00000X | Family Medicine | (* (Not Available)) | Primary |
Provider Name | Randy S Buckles |
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Provider Type | Practitioner - Family Practice |
Provider Identifiers | NPI Number: 1447268560 PECOS PAC ID: 6406895226 Enrollment ID: I20050429000819 |
Provider Name | Deborah L Uplinger |
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Provider Type | Practitioner - Nurse Practitioner |
Provider Identifiers | NPI Number: 1437165743 PECOS PAC ID: 4587668728 Enrollment ID: I20060831000169 |
Provider Name | Christopher S Buckles |
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Provider Type | Practitioner - Internal Medicine |
Provider Identifiers | NPI Number: 1790947901 PECOS PAC ID: 8820252125 Enrollment ID: I20120618000711 |
Provider Name | Danyelle D Kerns |
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Provider Type | Practitioner - Nurse Practitioner |
Provider Identifiers | NPI Number: 1669805818 PECOS PAC ID: 8820398043 Enrollment ID: I20151119001905 |