Full Name | |
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Speciality | Clinic/Center |
Location | 61 Highway Y, Ellington, Missouri |
Authorized Official Name and Position | Karen White (CEO) |
Authorized Official Contact | 5736632313 |
Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
Mailing Address | Practice Location Address |
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110 S 2nd St Ellington MO 63638-9400 Ph: (573) 663-2313 | 61 Highway Y Ellington MO 63638 Ph: (573) 663-2525 |
NPI Number | 1669575908 |
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Provider Enumeration Date | 09/05/2006 |
Last Update Date | 02/20/2017 |
Medicare PECOS PAC ID | 6709871007 |
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Medicare Enrollment ID | O20041210000173 |
Identifier | Type | State | Issuer |
---|---|---|---|
1669575908 | NPI | - | NPPES |
500217419 | Medicaid | MO |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
261QF0400X | Clinic/center - Federally Qualified Health Center (fqhc) | (* (Not Available)) | Primary |