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401 E Highway 19 Center MO 63436-1044 | |
(573) 267-3318 | |
(573) 267-3933 |
Full Name | |
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Speciality | Family Medicine |
Location | 401 E Highway 19, Center, Missouri |
Authorized Official Name and Position | Michael J Bukstein (PHYSICIAN EXECUTIVE DIRECTOR) |
Authorized Official Contact | 5732313172 |
Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
Mailing Address | Practice Location Address |
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100 Medical Dr Hannibal MO 63401-6877 Ph: (573) 221-5250 | 401 E Highway 19 Center MO 63436-1044 Ph: (573) 267-3318 |
NPI Number | 1174757504 |
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Provider Enumeration Date | 05/13/2009 |
Last Update Date | 04/18/2022 |
Identifier | Type | State | Issuer |
---|---|---|---|
1174757504 | NPI | - | NPPES |
500221007 | Medicaid | MO |
Taxonomy | Type | License (State) | Status |
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207Q00000X | Family Medicine | (* (Not Available)) | Primary |