Full Name | |
---|---|
Speciality | Clinic/Center |
Location | 755 Cowan Drive, Lebanon, Missouri |
Authorized Official Name and Position | Kevin Mcroberts (CEO) |
Authorized Official Contact | 5733488388 |
Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
Mailing Address | Practice Location Address |
---|---|
Po Box 801661 Kansas City MO 64180-1661 Ph: (573) 348-8000 | 755 Cowan Drive Lebanon MO 65536 Ph: (417) 532-2805 |
NPI Number | 1386311223 |
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Provider Enumeration Date | 08/27/2021 |
Last Update Date | 10/12/2023 |
Medicare PECOS PAC ID | 9133026776 |
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Medicare Enrollment ID | O20210922000428 |
Identifier | Type | State | Issuer |
---|---|---|---|
1386311223 | NPI | - | NPPES |
590107490 | Medicaid | MO |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
261QR1300X | Clinic/center - Rural Health | (* (Not Available)) | Primary |
Philip W Caster Md And John P Caster Md Llc Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 732 S Madison Ave, Lebanon, MO 65536 Phone: 417-532-9161 Fax: 417-532-8360 | |
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