Full Name | |
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Speciality | Clinic/Center |
Location | 404 W Rolla Rd, Salem, 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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645 Maryville Centre Dr Fl 3 Saint Louis MO 63141-5855 Ph: (417) 820-7133 | 404 W Rolla Rd Salem MO 65560 Ph: (573) 729-6225 |
NPI Number | 1497886451 |
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Provider Enumeration Date | 03/08/2007 |
Last Update Date | 12/04/2018 |
Medicare PECOS PAC ID | 7416865845 |
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Medicare Enrollment ID | O20101116001005 |
Identifier | Type | State | Issuer |
---|---|---|---|
1497886451 | NPI | - | NPPES |
593362908 | Medicaid | MO |
Charles W Cunningham Do Llc Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 1010 Hwy 32 East, Salem, MO 65560 Phone: 573-729-5533 Fax: 573-729-7754 | |
South Central Missouri Community Health Center Primary Care Clinic Medicare: Medicare Enrolled Practice Location: 601 S Mcarthur St, Salem, MO 65560 Phone: 573-426-2407 Fax: 573-426-6723 | |