| |
309 Garrett St Fredericktown MO 63645-1084 | |
(573) 783-4683 | |
(573) 783-4684 |
Full Name | |
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Speciality | Family Medicine |
Location | 309 Garrett St, Fredericktown, Missouri |
Authorized Official Name and Position | Michael Portacci (PRESIDENT) |
Authorized Official Contact | 6154657029 |
Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
Mailing Address | Practice Location Address |
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Po Box 504354 Saint Louis MO 63150-0001 Ph: (573) 783-4683 | 309 Garrett St Fredericktown MO 63645-1084 Ph: (573) 783-4683 |
NPI Number | 1063517613 |
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Provider Enumeration Date | 09/14/2006 |
Last Update Date | 07/21/2022 |
Identifier | Type | State | Issuer |
---|---|---|---|
1063517613 | NPI | - | NPPES |
15055 | Other | MO | MEDICARE GROUP NUMBER |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
207Q00000X | Family Medicine | (Missouri) | Primary |
261QR1300X | Clinic/center - Rural Health | (* (Not Available)) | Secondary |
Robbins Family Healthcare Llc Primary Care Clinic Medicare: Medicare Enrolled Practice Location: 355 N Chamber Dr, Fredericktown, MO 63645 Phone: 573-944-7231 Fax: 573-561-1166 | |
Chands' Medical Office Of Fredericktown Llc Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 101 N Chamber Dr, Fredericktown, MO 63645 Phone: 573-783-2320 Fax: 573-783-4494 |