Full Name | |
---|---|
Speciality | Clinic/Center |
Location | 221 Elm St, Hale, Missouri |
Authorized Official Name and Position | Amy Danielle Ireland (CFO) |
Authorized Official Contact | 6603296005 |
Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
Mailing Address | Practice Location Address |
---|---|
1502 N Jefferson St Carrollton MO 64633-1948 Ph: (660) 542-9998 | 221 Elm St Hale MO 64643-7113 Ph: (660) 565-2602 |
NPI Number | 1760772743 |
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Provider Enumeration Date | 04/12/2011 |
Last Update Date | 10/29/2021 |
Medicare PECOS PAC ID | 6800894379 |
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Medicare Enrollment ID | O20110512000437 |
Identifier | Type | State | Issuer |
---|---|---|---|
1760772743 | NPI | - | NPPES |
596548800 | Medicaid | MO |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
261QR1300X | Clinic/center - Rural Health | (Missouri) | Primary |