| |
110 S 2nd St Ellington MO 63638-9400 | |
(573) 663-2313 | |
(573) 663-2441 |
Full Name | |
---|---|
Speciality | Clinic/center - Federally Qualified Health Center (fqhc) |
Location | 110 S 2nd St, Ellington, Missouri |
Authorized Official Name and Position | Sherilyn Clark (CEO) |
Authorized Official Contact | 5736632313 |
Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
Mailing Address | Practice Location Address |
---|---|
Po Box 157 Ellington MO 63638-0157 Ph: (573) 663-2313 | 110 S 2nd St Ellington MO 63638-9400 Ph: (573) 663-2313 |
NPI Number | 1124295183 |
---|---|
Provider Enumeration Date | 05/09/2008 |
Last Update Date | 07/17/2013 |
Identifier | Type | State | Issuer |
---|---|---|---|
1124295183 | NPI | - | NPPES |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
261QF0400X | Clinic/center - Federally Qualified Health Center (fqhc) | (Missouri) | Primary |