Holden Family Care, Llc | |
612 E 10th St Holden MO 64040-9421 | |
(816) 732-6010 | |
(816) 732-6011 |
Full Name | Holden Family Care, Llc |
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Speciality | Clinic/Center |
Location | 612 E 10th St, Holden, Missouri |
Authorized Official Name and Position | Carol Jean Jackson (OFFICE MANAGER) |
Authorized Official Contact | 8167326010 |
Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
Mailing Address | Practice Location Address |
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Holden Family Care, Llc 612 E 10th St Holden MO 64040-9421 Ph: (816) 732-6010 | Holden Family Care, Llc 612 E 10th St Holden MO 64040-9421 Ph: (816) 732-6010 |
NPI Number | 1205154606 |
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Provider Enumeration Date | 05/10/2010 |
Last Update Date | 04/10/2015 |
Medicare PECOS PAC ID | 7113043001 |
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Medicare Enrollment ID | O20100928001615 |
Identifier | Type | State | Issuer |
---|---|---|---|
1205154606 | NPI | - | NPPES |
1205154606 | Medicaid | MO |
Taxonomy | Type | License (State) | Status |
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261QR1300X | Clinic/center - Rural Health | 076670 (Missouri) | Primary |
363L00000X | Nurse Practitioner | 076670 (Missouri) | Secondary |
Provider Name | Dorothy L Adams |
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Provider Type | Practitioner - Nurse Practitioner |
Provider Identifiers | NPI Number: 1043274210 PECOS PAC ID: 7517995178 Enrollment ID: I20050803001093 |
Provider Name | James D Lawrenzi |
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Provider Type | Practitioner - Hospitalist |
Provider Identifiers | NPI Number: 1174550313 PECOS PAC ID: 0941357669 Enrollment ID: I20090416000097 |