| Hannibal Clinic @ Palmyra | |
|
1811 S Main St Palmyra MO 63461-1961 | |
| (573) 769-2231 | |
| (573) 769-3953 |
| Full Name | Hannibal Clinic @ Palmyra |
|---|---|
| Speciality | Family Medicine |
| Location | 1811 S Main St, Palmyra, Missouri |
| Authorized Official Name and Position | Michael J Bukstein (PHYSICIAN EXEC DIRECTOR) |
| Authorized Official Contact | 5732313172 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Hannibal Clinic @ Palmyra 100 Medical Dr Hannibal MO 63401-6877 Ph: (573) 221-5250 | Hannibal Clinic @ Palmyra 1811 S Main St Palmyra MO 63461-1961 Ph: (573) 769-2231 |
| NPI Number | 1962481663 |
|---|---|
| Provider Enumeration Date | 01/11/2006 |
| Last Update Date | 04/18/2022 |
| Medicare PECOS PAC ID | 9931094182 |
|---|---|
| Medicare Enrollment ID | O20050310000149 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1962481663 | NPI | - | NPPES |
| 500221007 | Medicaid | MO |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | (* (Not Available)) | Primary |
| Provider Name | Rodney L Yager |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1851321202 PECOS PAC ID: 3779547856 Enrollment ID: I20041118000033 |
| Provider Name | Stephen E Halpin |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1346229937 PECOS PAC ID: 0042237877 Enrollment ID: I20051031000633 |
| Provider Name | Dale D Zimmerman |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1720169899 PECOS PAC ID: 3375632144 Enrollment ID: I20071130000515 |
| Provider Name | David J Knorr |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1255310850 PECOS PAC ID: 6406996065 Enrollment ID: I20091214000133 |
| Provider Name | Susan M Meidl |
|---|---|
| Provider Type | Practitioner - Dermatology |
| Provider Identifiers | NPI Number: 1881673457 PECOS PAC ID: 9739229394 Enrollment ID: I20091214000178 |
| Provider Name | Michelle Friedersdorf |
|---|---|
| Provider Type | Practitioner - Podiatry |
| Provider Identifiers | NPI Number: 1255310942 PECOS PAC ID: 5799827515 Enrollment ID: I20100116000168 |
| Provider Name | Scott Friedersdorf |
|---|---|
| Provider Type | Practitioner - Podiatry |
| Provider Identifiers | NPI Number: 1508845298 PECOS PAC ID: 1153463971 Enrollment ID: I20100116000175 |
| Provider Name | Prashanth Podaralla |
|---|---|
| Provider Type | Practitioner - Nephrology |
| Provider Identifiers | NPI Number: 1730226952 PECOS PAC ID: 5496886699 Enrollment ID: I20100702000389 |
| Provider Name | Justin Blair Imhof |
|---|---|
| Provider Type | Practitioner - Otolaryngology |
| Provider Identifiers | NPI Number: 1225066509 PECOS PAC ID: 7911175864 Enrollment ID: I20110719000757 |
| Provider Name | Gina Marie Pontius |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1871793257 PECOS PAC ID: 0749459808 Enrollment ID: I20110805000195 |
| Provider Name | Amber N Gottman |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1831589944 PECOS PAC ID: 6103142922 Enrollment ID: I20150313000111 |
| Provider Name | Kristin Nichole Bradshaw |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1568975183 PECOS PAC ID: 2567728074 Enrollment ID: I20171115002587 |
| Provider Name | Patsy J Hudson |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1902316607 PECOS PAC ID: 4284997412 Enrollment ID: I20180420001186 |
| Provider Name | Alyssa Crowe |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1336645035 PECOS PAC ID: 0345504155 Enrollment ID: I20180502002692 |
| Provider Name | Brian T Mcginn |
|---|---|
| Provider Type | Practitioner - Pediatric Medicine |
| Provider Identifiers | NPI Number: 1447683487 PECOS PAC ID: 4284955030 Enrollment ID: I20181128002586 |
| Provider Name | Dorothy E Swingle |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1174532493 PECOS PAC ID: 7719016708 Enrollment ID: I20210224000797 |
| Provider Name | Allison Leigh Rodgers |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1902567985 PECOS PAC ID: 9335536697 Enrollment ID: I20220505000774 |
| Provider Name | Sara Brown |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1861145732 PECOS PAC ID: 9335526342 Enrollment ID: I20220512002523 |
Blessing Health Palmyra Primary Care Clinic Medicare: Medicare Enrolled Practice Location: 6996 County Road 326, Palmyra, MO 63461 Phone: 573-769-3710 Fax: 573-769-3753 | |
Palmyra Clinic Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 6996 County Road 326, Palmyra, MO 63461 Phone: 573-769-3710 Fax: 573-769-3753 |