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104 East Highway 60 Mountain View MO 65548 | |
(417) 934-2251 | |
(417) 934-2871 |
Full Name | |
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Speciality | Clinic/Center |
Location | 104 East Highway 60, Mountain View, Missouri |
Authorized Official Name and Position | Robert Cavagnol (CHIEF PHYSICIAN OFFICER) |
Authorized Official Contact | 4178202705 |
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 505164 Saint Louis MO 63150-5164 Ph: (417) 820-2000 | 104 East Highway 60 Mountain View MO 65548 Ph: (417) 934-2251 |
NPI Number | 1003946732 |
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Provider Enumeration Date | 03/06/2007 |
Last Update Date | 12/04/2018 |
Medicare PECOS PAC ID | 7416865845 |
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Medicare Enrollment ID | O20101202000475 |
Identifier | Type | State | Issuer |
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1003946732 | NPI | - | NPPES |
592365415 | Medicaid | MO |