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904 Zimmerman Ave Cabool MO 65689-7365 | |
(417) 683-4831 | |
Not Available |
Full Name | |
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Speciality | Clinic/Center |
Location | 904 Zimmerman Ave, Cabool, Missouri |
Authorized Official Name and Position | Richard 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 Ava MO 65608-1359 Ph: (417) 683-4831 | 904 Zimmerman Ave Cabool MO 65689-7365 Ph: (417) 683-4831 |
NPI Number | 1710221130 |
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Provider Enumeration Date | 11/26/2012 |
Last Update Date | 11/26/2012 |
Medicare PECOS PAC ID | 3072423052 |
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Medicare Enrollment ID | O20140801000688 |
Identifier | Type | State | Issuer |
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1710221130 | NPI | - | NPPES |
Taxonomy | Type | License (State) | Status |
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261QF0400X | Clinic/center - Federally Qualified Health Center (fqhc) | (* (Not Available)) | Primary |
Douglas County Public Health Services Group, Inc. Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 2001 Dys Dr, Cabool, MO 65689 Phone: 417-962-4344 | |