| Ozarks Healthcare Mountain Grove | |
|
500 East 19th Street Suite A Mountain Grove MO 65711 | |
| (417) 926-6563 | |
| (417) 926-5820 |
| Full Name | Ozarks Healthcare Mountain Grove |
|---|---|
| Speciality | Clinic/Center |
| Location | 500 East 19th Street, Mountain Grove, Missouri |
| Authorized Official Name and Position | Thomas W. Keller (PRESIDENT AND CEO) |
| Authorized Official Contact | 4172569111 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Ozarks Healthcare Mountain Grove Po Box 1100 West Plains MO 65775-1100 Ph: (417) 256-9111 | Ozarks Healthcare Mountain Grove 500 East 19th Street Suite A Mountain Grove MO 65711 Ph: (417) 926-6563 |
| NPI Number | 1376679423 |
|---|---|
| Provider Enumeration Date | 02/25/2007 |
| Last Update Date | 11/13/2020 |
| Medicare PECOS PAC ID | 3870491863 |
|---|---|
| Medicare Enrollment ID | O20040721000658 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1376679423 | NPI | - | NPPES |
| 599301009 | Medicaid | MO |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QR1300X | Clinic/center - Rural Health | 17447 (Missouri) | Primary |
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