| Mountain Grove Medical And Laser Center Inc | |
|
601 N Busch Ave Mountain Grove MO 65711 | |
| (417) 926-6643 | |
| (417) 926-6317 |
| Full Name | Mountain Grove Medical And Laser Center Inc |
|---|---|
| Speciality | Clinic/center - Rural Health |
| Location | 601 N Busch Ave, Mountain Grove, Missouri |
| Authorized Official Name and Position | Doyle B Hill (PRESIDENT) |
| Authorized Official Contact | 4179266643 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Mountain Grove Medical And Laser Center Inc 601 N Busch Ave Mountain Grove MO 65711-1415 Ph: (417) 926-6643 | Mountain Grove Medical And Laser Center Inc 601 N Busch Ave Mountain Grove MO 65711 Ph: (417) 926-6643 |
| NPI Number | 1972573699 |
|---|---|
| Provider Enumeration Date | 01/25/2006 |
| Last Update Date | 05/14/2018 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1972573699 | NPI | - | NPPES |
| 793840 | Other | MO | RIVERBEND |
| 243394905 | Medicaid | MO |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 208D00000X | General Practice | R7130 (Missouri) | Secondary |
| 261QR1300X | Clinic/center - Rural Health | (* (Not Available)) | Primary |
Mountain Grove Medical And Laser Center Inc Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 601 N Busch Ave, Mountain Grove, MO 65711 Phone: 417-926-6643 Fax: 417-926-6317 | |