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816 E Main Willow Springs MO 65793 | |
(417) 269-2490 | |
(417) 269-2492 |
Full Name | |
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Speciality | Clinic/Center |
Location | 816 E Main, Willow Springs, Missouri |
Authorized Official Name and Position | Jacob Mcway (SR VP & CFO) |
Authorized Official Contact | 4172698811 |
Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
Mailing Address | Practice Location Address |
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Po Box 505673 Saint Louis MO 63150-5673 Ph: (417) 730-6430 | 816 E Main Willow Springs MO 65793 Ph: (417) 269-2490 |
NPI Number | 1407950520 |
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Provider Enumeration Date | 09/11/2006 |
Last Update Date | 09/27/2024 |
Medicare PECOS PAC ID | 1254248917 |
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Medicare Enrollment ID | O20030911000017 |
Identifier | Type | State | Issuer |
---|---|---|---|
1407950520 | NPI | - | NPPES |
590166500 | Medicaid | MO |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
207Q00000X | Family Medicine | (* (Not Available)) | Secondary |
261QR1300X | Clinic/center - Rural Health | (* (Not Available)) | Primary |
Valley Medical Center P.c. Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 308 S Harris St, Willow Springs, MO 65793 Phone: 417-469-3175 Fax: 417-469-1274 | |