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1165 E Cherry St Troy MO 63379-1520 | |
(636) 528-7722 | |
Not Available |
Full Name | |
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Speciality | Clinic/Center |
Location | 1165 E Cherry St, Troy, Missouri |
Authorized Official Name and Position | Mark Thorn (EXECUTIVE DIRECTOR FINANCE) |
Authorized Official Contact | 6365283329 |
Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
Mailing Address | Practice Location Address |
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1165 E Cherry St Troy MO 63379-1520 Ph: (636) 528-7722 | 1165 E Cherry St Troy MO 63379-1520 Ph: (636) 528-7722 |
NPI Number | 1316343494 |
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Provider Enumeration Date | 11/17/2014 |
Last Update Date | 09/27/2021 |
Medicare PECOS PAC ID | 5193040020 |
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Medicare Enrollment ID | O20150218000832 |
Identifier | Type | State | Issuer |
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1316343494 | NPI | - | NPPES |
Taxonomy | Type | License (State) | Status |
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261QR1300X | Clinic/center - Rural Health | (* (Not Available)) | Primary |
Lewis Meyerson, Md Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 104 Sarah Ann Blvd, Troy, MO 63379 Phone: 636-528-5281 Fax: 636-462-2637 | |