Full Name | |
---|---|
Speciality | Clinic/Center |
Location | 200 N Plum, Moline, Kansas |
Authorized Official Name and Position | Joshua Metzinger (CLINIC MANAGER) |
Authorized Official Contact | 6207582221 |
Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
Mailing Address | Practice Location Address |
---|---|
Po Box 155 200 N Plum Moline KS 67353-0155 Ph: (620) 647-8109 | 200 N Plum Moline KS 67353 Ph: (620) 647-8109 |
NPI Number | 1356360648 |
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Provider Enumeration Date | 07/18/2006 |
Last Update Date | 04/11/2023 |
Medicare PECOS PAC ID | 5294648937 |
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Medicare Enrollment ID | O20031111000433 |
Identifier | Type | State | Issuer |
---|---|---|---|
1356360648 | NPI | - | NPPES |
100005090F | Medicaid | KS |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
261QR1300X | Clinic/center - Rural Health | 173425 (Kansas) | Primary |