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18 Viburnum Center Rd Viburnum MO 65566 | |
(573) 244-5406 | |
(573) 244-5590 |
Full Name | |
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Speciality | Clinic/Center |
Location | 18 Viburnum Center Rd, Viburnum, 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 | 18 Viburnum Center Rd Viburnum MO 65566 Ph: (573) 244-5406 |
NPI Number | 1477657609 |
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Provider Enumeration Date | 09/08/2006 |
Last Update Date | 02/20/2017 |
Medicare PECOS PAC ID | 6709871007 |
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Medicare Enrollment ID | O20051116000515 |
Identifier | Type | State | Issuer |
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1477657609 | NPI | - | NPPES |
500324710 | Medicaid | MO |
Taxonomy | Type | License (State) | Status |
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261QF0400X | Clinic/center - Federally Qualified Health Center (fqhc) | (* (Not Available)) | Primary |