| |
2305 South 65 Highway, Building A Marshall MO 65340-3702 | |
(660) 886-7800 | |
(660) 831-3328 |
Full Name | |
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Speciality | Clinic/Center |
Location | 2305 South 65 Highway, Building A, Marshall, Missouri |
Authorized Official Name and Position | Nancy Harris (CFO/COO) |
Authorized Official Contact | 6608867231 |
Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
Mailing Address | Practice Location Address |
---|---|
2305 South 65 Highway, Building A Marshall MO 65340-3702 Ph: (660) 886-7800 | 2305 South 65 Highway, Building A Marshall MO 65340-3702 Ph: (660) 886-7800 |
NPI Number | 1093731986 |
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Provider Enumeration Date | 07/14/2006 |
Last Update Date | 03/05/2024 |
Medicare PECOS PAC ID | 2567351570 |
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Medicare Enrollment ID | O20040315000980 |
Identifier | Type | State | Issuer |
---|---|---|---|
1093731986 | NPI | - | NPPES |
268577 | Other | MO | MEDICARE - RHC |
1093731986 | Medicaid | MO | |
598987600 | Other | MO | MEDICAID - RHC |
508291606 | Medicaid | MO |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
261Q00000X | Clinic/center | (* (Not Available)) | Primary |
261QR1300X | Clinic/center - Rural Health | (* (Not Available)) | Secondary |
Provider Name | Craig G Simons |
---|---|
Provider Type | Practitioner - Emergency Medicine |
Provider Identifiers | NPI Number: 1073568846 PECOS PAC ID: 4082506050 Enrollment ID: I20040325000953 |
Provider Name | Michael O Turner |
---|---|
Provider Type | Practitioner - Pediatric Medicine |
Provider Identifiers | NPI Number: 1649233602 PECOS PAC ID: 5496747537 Enrollment ID: I20040331000303 |
Provider Name | Ravinder S Arora |
---|---|
Provider Type | Practitioner - Neurology |
Provider Identifiers | NPI Number: 1689674525 PECOS PAC ID: 9234109794 Enrollment ID: I20040730000594 |
Provider Name | Yan Chen |
---|---|
Provider Type | Practitioner - Gastroenterology |
Provider Identifiers | NPI Number: 1184627101 PECOS PAC ID: 1254306749 Enrollment ID: I20040828000012 |
Provider Name | Lorenzo Miles Romney |
---|---|
Provider Type | Practitioner - Family Practice |
Provider Identifiers | NPI Number: 1487623658 PECOS PAC ID: 9234104530 Enrollment ID: I20040831000402 |
Provider Name | Suzanne M Vogelsmeier |
---|---|
Provider Type | Practitioner - Nurse Practitioner |
Provider Identifiers | NPI Number: 1962408195 PECOS PAC ID: 0941278659 Enrollment ID: I20040921000469 |
Provider Name | James Howard Kerns |
---|---|
Provider Type | Practitioner - Obstetrics/gynecology |
Provider Identifiers | NPI Number: 1235187113 PECOS PAC ID: 8820053846 Enrollment ID: I20041201000265 |
Provider Name | Brenda K Dodds |
---|---|
Provider Type | Practitioner - Nurse Practitioner |
Provider Identifiers | NPI Number: 1467455568 PECOS PAC ID: 6608814553 Enrollment ID: I20050420001247 |
Provider Name | Craig E Mccoy |
---|---|
Provider Type | Practitioner - Obstetrics/gynecology |
Provider Identifiers | NPI Number: 1053312017 PECOS PAC ID: 4587617717 Enrollment ID: I20050613000933 |
Provider Name | Darin L Haug |
---|---|
Provider Type | Practitioner - Internal Medicine |
Provider Identifiers | NPI Number: 1902879760 PECOS PAC ID: 4880623388 Enrollment ID: I20050804001030 |
Provider Name | Laurie A Beach |
---|---|
Provider Type | Practitioner - Nurse Practitioner |
Provider Identifiers | NPI Number: 1811993264 PECOS PAC ID: 1456302033 Enrollment ID: I20050819000181 |
Provider Name | Guy A Corazzin |
---|---|
Provider Type | Practitioner - Certified Registered Nurse Anesthetist (crna) |
Provider Identifiers | NPI Number: 1336125095 PECOS PAC ID: 5496650970 Enrollment ID: I20051214000428 |
Provider Name | Roy J Elfrink |
---|---|
Provider Type | Practitioner - General Surgery |
Provider Identifiers | NPI Number: 1356344931 PECOS PAC ID: 3971504531 Enrollment ID: I20070124000606 |
Provider Name | Deborah A Herrmann |
---|---|
Provider Type | Practitioner - Family Practice |
Provider Identifiers | NPI Number: 1508862756 PECOS PAC ID: 0749255651 Enrollment ID: I20070316000340 |
Provider Name | Paul J Peterson |
---|---|
Provider Type | Practitioner - Certified Registered Nurse Anesthetist (crna) |
Provider Identifiers | NPI Number: 1861448524 PECOS PAC ID: 8123045663 Enrollment ID: I20070327000605 |
Provider Name | Preston B Howerton |
---|---|
Provider Type | Practitioner - Emergency Medicine |
Provider Identifiers | NPI Number: 1023004652 PECOS PAC ID: 6406954395 Enrollment ID: I20070530000385 |
Provider Name | Pearl Carrillo |
---|---|
Provider Type | Practitioner - Family Practice |
Provider Identifiers | NPI Number: 1487602991 PECOS PAC ID: 9133229222 Enrollment ID: I20070702000398 |
Provider Name | Andrew J Green |
---|---|
Provider Type | Practitioner - Certified Registered Nurse Anesthetist (crna) |
Provider Identifiers | NPI Number: 1467488429 PECOS PAC ID: 1557364239 Enrollment ID: I20070816000868 |
Provider Name | David J Keuhn |
---|---|
Provider Type | Practitioner - Family Practice |
Provider Identifiers | NPI Number: 1124061056 PECOS PAC ID: 9739288325 Enrollment ID: I20071013000108 |
Provider Name | John B Brizendine |
---|---|
Provider Type | Practitioner - General Surgery |
Provider Identifiers | NPI Number: 1457575813 PECOS PAC ID: 7911060702 Enrollment ID: I20090105000442 |
Provider Name | Constance Susan Cass |
---|---|
Provider Type | Practitioner - Nurse Practitioner |
Provider Identifiers | NPI Number: 1992959217 PECOS PAC ID: 0547326183 Enrollment ID: I20090305000283 |
Provider Name | Abigail Nicole Koetting |
---|---|
Provider Type | Practitioner - Nurse Practitioner |
Provider Identifiers | NPI Number: 1528392024 PECOS PAC ID: 7618018151 Enrollment ID: I20100106000655 |
Provider Name | William J Smith |
---|---|
Provider Type | Practitioner - Obstetrics/gynecology |
Provider Identifiers | NPI Number: 1760485312 PECOS PAC ID: 8527033430 Enrollment ID: I20100325000104 |
Provider Name | Paul T Brizendine |
---|---|
Provider Type | Practitioner - Emergency Medicine |
Provider Identifiers | NPI Number: 1265411045 PECOS PAC ID: 6901701697 Enrollment ID: I20100728000388 |
Provider Name | Jack R Uhrig |
---|---|
Provider Type | Practitioner - Internal Medicine |
Provider Identifiers | NPI Number: 1720024557 PECOS PAC ID: 3678676731 Enrollment ID: I20100805000893 |
Provider Name | Timothy Ryan |
---|---|
Provider Type | Practitioner - Internal Medicine |
Provider Identifiers | NPI Number: 1790721520 PECOS PAC ID: 4587767645 Enrollment ID: I20100805000949 |
Provider Name | Jason E Gault |
---|---|
Provider Type | Practitioner - General Surgery |
Provider Identifiers | NPI Number: 1861608192 PECOS PAC ID: 0840315636 Enrollment ID: I20100916001035 |
Provider Name | Megan L Shepard |
---|---|
Provider Type | Practitioner - Certified Nurse Midwife (cnm) |
Provider Identifiers | NPI Number: 1033401328 PECOS PAC ID: 7416133681 Enrollment ID: I20110524000476 |
Provider Name | Deanna C Donnell |
---|---|
Provider Type | Practitioner - Certified Nurse Midwife (cnm) |
Provider Identifiers | NPI Number: 1588667166 PECOS PAC ID: 6507037991 Enrollment ID: I20110915000022 |
Provider Name | Rori A Schreiman |
---|---|
Provider Type | Practitioner - Nurse Practitioner |
Provider Identifiers | NPI Number: 1962774893 PECOS PAC ID: 9032370861 Enrollment ID: I20120423000055 |
Provider Name | Kellie Louise Shuck |
---|---|
Provider Type | Practitioner - Certified Clinical Nurse Specialist (cns) |
Provider Identifiers | NPI Number: 1598720534 PECOS PAC ID: 6901906197 Enrollment ID: I20130115000382 |
Provider Name | Cayla L Malter |
---|---|
Provider Type | Practitioner - Clinical Social Worker |
Provider Identifiers | NPI Number: 1861730517 PECOS PAC ID: 8022255074 Enrollment ID: I20130510000150 |
Provider Name | Diane M Weinreich |
---|---|
Provider Type | Practitioner - Nurse Practitioner |
Provider Identifiers | NPI Number: 1427293067 PECOS PAC ID: 1951537513 Enrollment ID: I20131204000782 |
Provider Name | Melanie E Elfrink |
---|---|
Provider Type | Practitioner - Family Practice |
Provider Identifiers | NPI Number: 1629203179 PECOS PAC ID: 2961630462 Enrollment ID: I20140108000322 |
Provider Name | Matthew W Oxford |
---|---|
Provider Type | Practitioner - Family Practice |
Provider Identifiers | NPI Number: 1124359203 PECOS PAC ID: 3678744943 Enrollment ID: I20140324000318 |
Provider Name | James B Smith |
---|---|
Provider Type | Practitioner - Family Practice |
Provider Identifiers | NPI Number: 1376986901 PECOS PAC ID: 9234458753 Enrollment ID: I20150505002512 |
Provider Name | Karla Dora Dobbs |
---|---|
Provider Type | Practitioner - Family Practice |
Provider Identifiers | NPI Number: 1164786604 PECOS PAC ID: 7315186244 Enrollment ID: I20150702001343 |
Provider Name | Samuel M Temesgen |
---|---|
Provider Type | Practitioner - Psychiatry |
Provider Identifiers | NPI Number: 1972891455 PECOS PAC ID: 2264747211 Enrollment ID: I20150819008760 |
Provider Name | Ann M Murphy |
---|---|
Provider Type | Practitioner - Family Practice |
Provider Identifiers | NPI Number: 1831153824 PECOS PAC ID: 1951435098 Enrollment ID: I20160125002064 |
Provider Name | Jared K Romney |
---|---|
Provider Type | Practitioner - Family Practice |
Provider Identifiers | NPI Number: 1194160028 PECOS PAC ID: 9537301247 Enrollment ID: I20160602001277 |
Provider Name | Trent A Link |
---|---|
Provider Type | Practitioner - Nurse Practitioner |
Provider Identifiers | NPI Number: 1154779866 PECOS PAC ID: 6305138793 Enrollment ID: I20160705001588 |
Provider Name | Alyssa Ferri |
---|---|
Provider Type | Practitioner - Certified Clinical Nurse Specialist (cns) |
Provider Identifiers | NPI Number: 1477924876 PECOS PAC ID: 7113219908 Enrollment ID: I20160715000062 |
Provider Name | Priya Gujarati |
---|---|
Provider Type | Practitioner - Emergency Medicine |
Provider Identifiers | NPI Number: 1518305267 PECOS PAC ID: 7113221565 Enrollment ID: I20160830001775 |
Provider Name | Kylie Clemons |
---|---|
Provider Type | Practitioner - Chiropractic |
Provider Identifiers | NPI Number: 1447706718 PECOS PAC ID: 7911285887 Enrollment ID: I20161027000592 |
Provider Name | Sara Walker |
---|---|
Provider Type | Practitioner - Registered Dietitian Or Nutrition Professional |
Provider Identifiers | NPI Number: 1447707419 PECOS PAC ID: 9234411513 Enrollment ID: I20170120002363 |
Provider Name | Heather Arnold |
---|---|
Provider Type | Practitioner - Nurse Practitioner |
Provider Identifiers | NPI Number: 1700328622 PECOS PAC ID: 9032487988 Enrollment ID: I20170616001594 |
Provider Name | Erin Elizabeth Finkeldei |
---|---|
Provider Type | Practitioner - Nurse Practitioner |
Provider Identifiers | NPI Number: 1477073328 PECOS PAC ID: 0042589905 Enrollment ID: I20170707002962 |
Provider Name | Rebecca L Pence |
---|---|
Provider Type | Practitioner - Nurse Practitioner |
Provider Identifiers | NPI Number: 1972026151 PECOS PAC ID: 6901178979 Enrollment ID: I20170825001727 |
Provider Name | William L Pearman |
---|---|
Provider Type | Practitioner - Nurse Practitioner |
Provider Identifiers | NPI Number: 1659860765 PECOS PAC ID: 8527249804 Enrollment ID: I20180621001563 |
Provider Name | Anisa R Burdick |
---|---|
Provider Type | Practitioner - Nurse Practitioner |
Provider Identifiers | NPI Number: 1235610395 PECOS PAC ID: 9638420722 Enrollment ID: I20181001000145 |
Provider Name | Andrew Richard Wyant |
---|---|
Provider Type | Practitioner - General Practice |
Provider Identifiers | NPI Number: 1821087172 PECOS PAC ID: 3870407323 Enrollment ID: I20190116001803 |
Provider Name | Angela L Lybarger |
---|---|
Provider Type | Practitioner - Nurse Practitioner |
Provider Identifiers | NPI Number: 1013480979 PECOS PAC ID: 5799022356 Enrollment ID: I20190122000728 |
Provider Name | Grace Jackson |
---|---|
Provider Type | Practitioner - Psychiatry |
Provider Identifiers | NPI Number: 1659460814 PECOS PAC ID: 4183760945 Enrollment ID: I20190404002390 |
Provider Name | Justin Cortez |
---|---|
Provider Type | Practitioner - Nurse Practitioner |
Provider Identifiers | NPI Number: 1356801328 PECOS PAC ID: 3476894148 Enrollment ID: I20190405001002 |
Provider Name | Logan G Smith |
---|---|
Provider Type | Practitioner - Certified Registered Nurse Anesthetist (crna) |
Provider Identifiers | NPI Number: 1467975441 PECOS PAC ID: 9830461482 Enrollment ID: I20191231001475 |
Provider Name | Patricia Lynn Klinger Day |
---|---|
Provider Type | Practitioner - Nurse Practitioner |
Provider Identifiers | NPI Number: 1497306773 PECOS PAC ID: 6709213549 Enrollment ID: I20200217004455 |
Provider Name | Beatriz Fortaleza |
---|---|
Provider Type | Practitioner - Nurse Practitioner |
Provider Identifiers | NPI Number: 1063044626 PECOS PAC ID: 3173952082 Enrollment ID: I20200327002422 |
Provider Name | Christina Ann Williams |
---|---|
Provider Type | Practitioner - Nurse Practitioner |
Provider Identifiers | NPI Number: 1124614052 PECOS PAC ID: 3779990718 Enrollment ID: I20210318001955 |
Provider Name | Alicia M Bean |
---|---|
Provider Type | Practitioner - Family Practice |
Provider Identifiers | NPI Number: 1972629749 PECOS PAC ID: 5698960946 Enrollment ID: I20210331002389 |
Provider Name | Kurt W Schroer |
---|---|
Provider Type | Practitioner - Family Practice |
Provider Identifiers | NPI Number: 1104288646 PECOS PAC ID: 3072841485 Enrollment ID: I20220119002335 |
Provider Name | Khoa Nguyen |
---|---|
Provider Type | Practitioner - Psychiatry |
Provider Identifiers | NPI Number: 1245674159 PECOS PAC ID: 3779784699 Enrollment ID: I20220307000635 |
Provider Name | Amber Renee Drumheller |
---|---|
Provider Type | Practitioner - Nurse Practitioner |
Provider Identifiers | NPI Number: 1164180170 PECOS PAC ID: 1254718497 Enrollment ID: I20220510000721 |
Provider Name | Donald Baracskay |
---|---|
Provider Type | Practitioner - Psychiatry |
Provider Identifiers | NPI Number: 1760564207 PECOS PAC ID: 3072406891 Enrollment ID: I20220525002483 |
Provider Name | Mary J Drenon |
---|---|
Provider Type | Practitioner - Nurse Practitioner |
Provider Identifiers | NPI Number: 1790434413 PECOS PAC ID: 1557749298 Enrollment ID: I20220608000886 |
Provider Name | Madelyne Elyse Sanders |
---|---|
Provider Type | Practitioner - Nurse Practitioner |
Provider Identifiers | NPI Number: 1245995935 PECOS PAC ID: 9537549845 Enrollment ID: I20220705001242 |
Provider Name | Kayode Wemimo |
---|---|
Provider Type | Practitioner - Nurse Practitioner |
Provider Identifiers | NPI Number: 1932852449 PECOS PAC ID: 3971983149 Enrollment ID: I20220706000390 |
Provider Name | Melissa Marie Kleinschmidt |
---|---|
Provider Type | Practitioner - Mental Health Counselor |
Provider Identifiers | NPI Number: 1962619809 PECOS PAC ID: 7416392352 Enrollment ID: I20240229004194 |
Provider Name | Elizabeth Marie Sandidge |
---|---|
Provider Type | Practitioner - Nurse Practitioner |
Provider Identifiers | NPI Number: 1144089806 PECOS PAC ID: 0547608960 Enrollment ID: I20240404002015 |
Provider Name | Kaylea Bultmann |
---|---|
Provider Type | Practitioner - Nurse Practitioner |
Provider Identifiers | NPI Number: 1811761760 PECOS PAC ID: 4486092350 Enrollment ID: I20240411000242 |
Provider Name | Jacob A Poore |
---|---|
Provider Type | Practitioner - Certified Registered Nurse Anesthetist (crna) |
Provider Identifiers | NPI Number: 1598433245 PECOS PAC ID: 3072051424 Enrollment ID: I20240815003132 |
Mid-missouri Family Health, Llc Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 78 S. Jefferson, Marshall, MO 65340 Phone: 660-831-1175 | |
Marshall Mo Chiropractic Llc Primary Care Clinic Medicare: Medicare Enrolled Practice Location: 754 S Odell Ave, Marshall, MO 65340 Phone: 660-886-7134 Fax: 660-886-7135 | |
D. J. Fahnestock, D. C., P. C. Primary Care Clinic Medicare: Medicare Enrolled Practice Location: 269 S Jefferson Ave, Marshall, MO 65340 Phone: 660-886-6903 Fax: 660-886-6904 | |
Ulbrich Family Medicine, Llc Primary Care Clinic Medicare: Medicare Enrolled Practice Location: 2301 S Highway 65, Suite 2, Marshall, MO 65340 Phone: 660-631-3386 |