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504 Nw 10th Avenue Ava MO 65608-1359 | |
(417) 683-4831 | |
(417) 683-1602 |
Full Name | |
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Speciality | Clinic/Center |
Location | 504 Nw 10th Avenue, Ava, Missouri |
Authorized Official Name and Position | Richard R Sims (CEO) |
Authorized Official Contact | 4176834831 |
Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
Mailing Address | Practice Location Address |
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Po Box 1359 504 Nw 10th Ave Ava MO 65608-1359 Ph: (417) 683-4831 | 504 Nw 10th Avenue Ava MO 65608-1359 Ph: (417) 683-4831 |
NPI Number | 1912904145 |
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Provider Enumeration Date | 07/01/2005 |
Last Update Date | 01/09/2008 |
Medicare PECOS PAC ID | 3072423052 |
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Medicare Enrollment ID | O20030630000024 |
Identifier | Type | State | Issuer |
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1912904145 | NPI | - | NPPES |
Taxonomy | Type | License (State) | Status |
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261QF0400X | Clinic/center - Federally Qualified Health Center (fqhc) | (* (Not Available)) | 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 | |