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307 S Broadway Salisbury MO 65281-1037 | |
(660) 388-6446 | |
(660) 388-6870 |
Full Name | |
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Speciality | Clinic/Center |
Location | 307 S Broadway, Salisbury, Missouri |
Authorized Official Name and Position | Teresa L Porter (CREDENTIALING MANAGER) |
Authorized Official Contact | 6608908156 |
Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
Mailing Address | Practice Location Address |
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1800 Community Clinton MO 64735-8804 Ph: (660) 885-8131 | 307 S Broadway Salisbury MO 65281-1037 Ph: (660) 388-6446 |
NPI Number | 1346213535 |
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Provider Enumeration Date | 02/09/2006 |
Last Update Date | 10/30/2020 |
Medicare PECOS PAC ID | 1951206754 |
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Medicare Enrollment ID | O20201110000546 |
Identifier | Type | State | Issuer |
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1346213535 | NPI | - | NPPES |
507299600 | Medicaid | MO |
Taxonomy | Type | License (State) | Status |
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261QF0400X | Clinic/center - Federally Qualified Health Center (fqhc) | (* (Not Available)) | Primary |