| Grace Family Medical Clinic, Llc | |
|
1206 Ward Ave Caruthersville MO 63830-2204 | |
| (573) 922-5111 | |
| (573) 922-5126 |
| Full Name | Grace Family Medical Clinic, Llc |
|---|---|
| Speciality | Internal Medicine |
| Location | 1206 Ward Ave, Caruthersville, Missouri |
| Authorized Official Name and Position | Joseph M Kulpeksa (OWNER) |
| Authorized Official Contact | 5739225111 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Grace Family Medical Clinic, Llc 1206 Ward Ave Caruthersville MO 63830-2204 Ph: (573) 922-5111 | Grace Family Medical Clinic, Llc 1206 Ward Ave Caruthersville MO 63830-2204 Ph: (573) 922-5111 |
| NPI Number | 1780119651 |
|---|---|
| Provider Enumeration Date | 04/27/2017 |
| Last Update Date | 04/27/2017 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1780119651 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207R00000X | Internal Medicine | 117451 (Missouri) | Primary |
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