Full Name | |
---|---|
Speciality | Clinic/Center |
Location | 904 S Pine St, Richland, Missouri |
Authorized Official Name and Position | Stuart Stangeland (SENIOR VICE PRESIDENT) |
Authorized Official Contact | 4178202000 |
Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
Mailing Address | Practice Location Address |
---|---|
500 Porter Ave Aurora MO 65605-2365 Ph: (417) 820-7133 | 904 S Pine St Richland MO 65556 Ph: (573) 765-2938 |
NPI Number | 1972635639 |
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Provider Enumeration Date | 03/09/2007 |
Last Update Date | 07/18/2023 |
Medicare PECOS PAC ID | 7416865845 |
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Medicare Enrollment ID | O20090604000143 |
Identifier | Type | State | Issuer |
---|---|---|---|
1972635639 | NPI | - | NPPES |
595920901 | Medicaid | MO |