Fordland Clinic, Inc. | |
1059 Barton Dr Fordland MO 65652-7350 | |
(417) 767-2273 | |
(417) 767-4054 |
Full Name | Fordland Clinic, Inc. |
---|---|
Speciality | Clinic/Center |
Location | 1059 Barton Dr, Fordland, Missouri |
Authorized Official Name and Position | Joan Twiton (EXECUTIVE DIRECTOR) |
Authorized Official Contact | 4177672273 |
Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
Mailing Address | Practice Location Address |
---|---|
Fordland Clinic, Inc. 1059 Barton Dr Fordland MO 65652-7350 Ph: (417) 767-2273 | Fordland Clinic, Inc. 1059 Barton Dr Fordland MO 65652-7350 Ph: (417) 767-2273 |
NPI Number | 1881607612 |
---|---|
Provider Enumeration Date | 08/14/2006 |
Last Update Date | 06/19/2019 |
Medicare PECOS PAC ID | 5597794552 |
---|---|
Medicare Enrollment ID | O20050913000367 |
Identifier | Type | State | Issuer |
---|---|---|---|
1881607612 | NPI | - | NPPES |
508519105 | Medicaid | MO |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
261QF0400X | Clinic/center - Federally Qualified Health Center (fqhc) | 26-1009 (Missouri) | Primary |
261QR1300X | Clinic/center - Rural Health | 263865 (Missouri) | Secondary |
Provider Name | Mark J Brady |
---|---|
Provider Type | Practitioner - Emergency Medicine |
Provider Identifiers | NPI Number: 1366439630 PECOS PAC ID: 5092707604 Enrollment ID: I20040402000072 |
Provider Name | Robert G Marsh |
---|---|
Provider Type | Practitioner - Nurse Practitioner |
Provider Identifiers | NPI Number: 1679570287 PECOS PAC ID: 3274501713 Enrollment ID: I20040922000310 |
Provider Name | Thomas L Huffman |
---|---|
Provider Type | Practitioner - Emergency Medicine |
Provider Identifiers | NPI Number: 1396776761 PECOS PAC ID: 0547226417 Enrollment ID: I20041203000038 |
Provider Name | Angela Coleen Moore Clay |
---|---|
Provider Type | Practitioner - Family Practice |
Provider Identifiers | NPI Number: 1992899645 PECOS PAC ID: 7517041627 Enrollment ID: I20080228000166 |
Provider Name | Jane B Stonner |
---|---|
Provider Type | Practitioner - Nurse Practitioner |
Provider Identifiers | NPI Number: 1871690172 PECOS PAC ID: 6103963640 Enrollment ID: I20091102000334 |
Provider Name | Debby Carl |
---|---|
Provider Type | Practitioner - Nurse Practitioner |
Provider Identifiers | NPI Number: 1891147104 PECOS PAC ID: 3870886617 Enrollment ID: I20160801001696 |
Provider Name | Kiran Dhaliwal |
---|---|
Provider Type | Practitioner - Nurse Practitioner |
Provider Identifiers | NPI Number: 1336664895 PECOS PAC ID: 8426452921 Enrollment ID: I20210805001419 |
Provider Name | Renae Jenelle Richardson |
---|---|
Provider Type | Practitioner - Nurse Practitioner |
Provider Identifiers | NPI Number: 1659045847 PECOS PAC ID: 4486050036 Enrollment ID: I20210907001174 |
Provider Name | Hyojin Meadows |
---|---|
Provider Type | Practitioner - Nurse Practitioner |
Provider Identifiers | NPI Number: 1356816383 PECOS PAC ID: 0547505034 Enrollment ID: I20211109000330 |
Provider Name | Allie Jackson |
---|---|
Provider Type | Practitioner - Nurse Practitioner |
Provider Identifiers | NPI Number: 1053983734 PECOS PAC ID: 8527457456 Enrollment ID: I20211116000835 |
Provider Name | Benton Drew Tolleson |
---|---|
Provider Type | Practitioner - Clinical Social Worker |
Provider Identifiers | NPI Number: 1477199503 PECOS PAC ID: 1052765195 Enrollment ID: I20230923000519 |
Provider Name | Ronica Jean Duncan |
---|---|
Provider Type | Practitioner - Clinical Social Worker |
Provider Identifiers | NPI Number: 1700859329 PECOS PAC ID: 6103271499 Enrollment ID: I20231005002887 |
Provider Name | Theresa Anne Griffith |
---|---|
Provider Type | Practitioner - Mental Health Counselor |
Provider Identifiers | NPI Number: 1467731018 PECOS PAC ID: 8022453075 Enrollment ID: I20240229000757 |
Provider Name | Delana Shoemake |
---|---|
Provider Type | Practitioner - Nurse Practitioner |
Provider Identifiers | NPI Number: 1932963360 PECOS PAC ID: 8224474788 Enrollment ID: I20240307000943 |
Fordland Clinic, Inc. Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 1059 Barton Dr, Fordland, MO 65652 Phone: 417-767-2273 Fax: 417-767-4054 |