Full Name | |
---|---|
Speciality | Clinic/center - Federally Qualified Health Center (fqhc) |
Location | 504 Nw 10th Ave, Ava, Missouri |
Authorized Official Name and Position | Jennifer Heinlein (HRO) |
Authorized Official Contact | 4176834831 |
Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
Mailing Address | Practice Location Address |
---|---|
Po Box 1359 Ava MO 65608-1359 Ph: (417) 683-4831 | 504 Nw 10th Ave Ava MO 65608 Ph: (417) 683-4831 |
NPI Number | 1871797597 |
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Provider Enumeration Date | 06/14/2007 |
Last Update Date | 07/13/2007 |
Identifier | Type | State | Issuer |
---|---|---|---|
1871797597 | NPI | - | NPPES |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
261QF0400X | Clinic/center - Federally Qualified Health Center (fqhc) | 2007014535 (Missouri) | Primary |
Douglas County Health Department Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 603 Nw 12th St, Building C, Ava, MO 65608 Phone: 417-683-4174 Fax: 417-683-4111 | |