| Mullock Health Care Llc | |
|
2332 S Main St Maryville MO 64468-3622 | |
| (660) 562-2223 | |
| (660) 562-2230 |
| Full Name | Mullock Health Care Llc |
|---|---|
| Speciality | Clinic/Center |
| Location | 2332 S Main St, Maryville, Missouri |
| Authorized Official Name and Position | Dallas Wayne Mullock (OWNER) |
| Authorized Official Contact | 6605622223 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Mullock Health Care Llc 2332 S Main St Maryville MO 64468-3622 Ph: (660) 562-2223 | Mullock Health Care Llc 2332 S Main St Maryville MO 64468-3622 Ph: (660) 562-2223 |
| NPI Number | 1881224707 |
|---|---|
| Provider Enumeration Date | 01/20/2020 |
| Last Update Date | 05/06/2024 |
| Medicare PECOS PAC ID | 4587091541 |
|---|---|
| Medicare Enrollment ID | O20200304000180 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1881224707 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261Q00000X | Clinic/center | (* (Not Available)) | Primary |
| Provider Name | Dallas W Mullock |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1134504012 PECOS PAC ID: 5496182453 Enrollment ID: I20200304000229 |
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