| Missouri Highlands Mobile Dental Clinic | |
|
1407 N Westwood Blvd Poplar Bluff MO 63901-3315 | |
| (573) 663-2313 | |
| Not Available |
| Full Name | Missouri Highlands Mobile Dental Clinic |
|---|---|
| Speciality | Clinic/Center |
| Location | 1407 N Westwood Blvd, Poplar Bluff, 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 |
|---|---|
| Missouri Highlands Mobile Dental Clinic Po Box 157 Ellington MO 63638-0157 Ph: (573) 663-2313 | Missouri Highlands Mobile Dental Clinic 1407 N Westwood Blvd Poplar Bluff MO 63901-3315 Ph: (573) 663-2313 |
| NPI Number | 1811428402 |
|---|---|
| Provider Enumeration Date | 03/24/2017 |
| Last Update Date | 06/20/2022 |
| Medicare PECOS PAC ID | 6709871007 |
|---|---|
| Medicare Enrollment ID | O20170919001262 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1811428402 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QF0400X | Clinic/center - Federally Qualified Health Center (fqhc) | (Missouri) | Primary |
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