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612 E High St Potosi MO 63664-1429 | |
(573) 438-3733 | |
(573) 438-0046 |
Full Name | |
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Speciality | Clinic/Center |
Location | 612 E High St, Potosi, Missouri |
Authorized Official Name and Position | Jeffrey Paul Tindall (OWNER) |
Authorized Official Contact | 5734383733 |
Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
Mailing Address | Practice Location Address |
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612 E High St Ste 110 Potosi MO 63664-1425 Ph: (573) 438-7333 | 612 E High St Potosi MO 63664-1429 Ph: (573) 438-3733 |
NPI Number | 1730588674 |
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Provider Enumeration Date | 08/16/2014 |
Last Update Date | 10/03/2023 |
Medicare PECOS PAC ID | 3274755145 |
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Medicare Enrollment ID | O20150107000100 |
Identifier | Type | State | Issuer |
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1730588674 | NPI | - | NPPES |
1528306652 | Other | MO | PEDIATRIC NP |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
261QR1300X | Clinic/center - Rural Health | (* (Not Available)) | Primary |
Provider Name | Shayne S Keddy |
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Provider Type | Practitioner - Family Practice |
Provider Identifiers | NPI Number: 1861465627 PECOS PAC ID: 0446202873 Enrollment ID: I20050215000019 |
Dr. Gregory K. Terpstra D.o., Family Practice, L.l.c. Primary Care Clinic Medicare: Medicare Enrolled Practice Location: 612 E High St Ste 210, Potosi, MO 63664 Phone: 573-438-3660 Fax: 573-438-1140 | |
Great Mines Health Center Primary Care Clinic Medicare: Medicare Enrolled Practice Location: #1 Southtowne Drive, Potosi, MO 63664 Phone: 573-438-9355 Fax: 573-438-7892 | |