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600 W Morrison St Suite 5 Fayette MO 65248-1075 | |
(660) 248-2900 | |
(660) 248-1544 |
Full Name | |
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Speciality | Clinic/Center |
Location | 600 W Morrison St, Fayette, Missouri |
Authorized Official Name and Position | Nancy Harris (CFO/COO) |
Authorized Official Contact | 6608867231 |
Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
Mailing Address | Practice Location Address |
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2305 S Highway 65 Marshall MO 65340-3702 Ph: (660) 886-7431 | 600 W Morrison St Suite 5 Fayette MO 65248-1075 Ph: (660) 248-2900 |
NPI Number | 1316140494 |
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Provider Enumeration Date | 06/07/2007 |
Last Update Date | 03/05/2024 |
Medicare PECOS PAC ID | 2567351570 |
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Medicare Enrollment ID | O20150806011729 |
Identifier | Type | State | Issuer |
---|---|---|---|
1316140494 | NPI | - | NPPES |
503959108 | Medicaid | MO |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
261QP2300X | Clinic/center - Primary Care | (Missouri) | Secondary |
261QR1300X | Clinic/center - Rural Health | 27-56 (Missouri) | Primary |