Full Name | |
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Speciality | Clinic/Center |
Location | 100 N Main St, Gideon, Missouri |
Authorized Official Name and Position | Timothy William Mcpherson (OWNER) |
Authorized Official Contact | 5736952181 |
Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
Mailing Address | Practice Location Address |
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901 W Commercial St Kennett MO 63857-1100 Ph: (573) 717-1072 | 100 N Main St Gideon MO 63848 Ph: (573) 448-3800 |
NPI Number | 1457099046 |
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Provider Enumeration Date | 05/24/2022 |
Last Update Date | 06/01/2022 |
Medicare PECOS PAC ID | 5698773539 |
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Medicare Enrollment ID | O20220622002578 |
Identifier | Type | State | Issuer |
---|---|---|---|
1457099046 | NPI | - | NPPES |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
261QR1300X | Clinic/center - Rural Health | (* (Not Available)) | Primary |