| Kneibert Clinic Llc | |
|
686 Lester St Poplar Bluff MO 63901 | |
| (573) 686-2411 | |
| (573) 686-8452 |
| Full Name | Kneibert Clinic Llc |
|---|---|
| Speciality | Clinic/Center |
| Location | 686 Lester St, Poplar Bluff, Missouri |
| Authorized Official Name and Position | Robert E Christian (ADMINISTRATOR) |
| Authorized Official Contact | 5737787210 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Kneibert Clinic Llc Po Box 220 Poplar Bluff MO 63902 Ph: (573) 686-2411 | Kneibert Clinic Llc 686 Lester St Poplar Bluff MO 63901 Ph: (573) 686-2411 |
| NPI Number | 1104804699 |
|---|---|
| Provider Enumeration Date | 01/04/2006 |
| Last Update Date | 03/22/2012 |
| Medicare PECOS PAC ID | 0446160212 |
|---|---|
| Medicare Enrollment ID | O20040407000054 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1104804699 | NPI | - | NPPES |
| 107927002 | Medicaid | AR | |
| 500295407 | Medicaid | MO |
| Provider Name | Linda Hammonds |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1447461199 PECOS PAC ID: 2668573395 Enrollment ID: I20080108000186 |
| Provider Name | Jill M Mcgruder |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1659606713 PECOS PAC ID: 8224171137 Enrollment ID: I20100201000372 |
| Provider Name | Bennie Till |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1235118928 PECOS PAC ID: 5890605661 Enrollment ID: I20100603000627 |
| Provider Name | Roger Bost |
|---|---|
| Provider Type | Practitioner - Pediatric Medicine |
| Provider Identifiers | NPI Number: 1881672418 PECOS PAC ID: 1254241037 Enrollment ID: I20100603000665 |
| Provider Name | Rebecca J Pinchoff |
|---|---|
| Provider Type | Practitioner - Pediatric Medicine |
| Provider Identifiers | NPI Number: 1811057565 PECOS PAC ID: 3971789736 Enrollment ID: I20110512000679 |
| Provider Name | Michael Dewayne Roach |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1740592435 PECOS PAC ID: 7719153279 Enrollment ID: I20121002000775 |
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