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320 N. 14th Street Rich Hill MO 64779-2145 | |
(417) 395-2150 | |
(417) 395-2153 |
Full Name | |
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Speciality | Clinic/Center |
Location | 320 N. 14th Street, Rich Hill, Missouri |
Authorized Official Name and Position | Jason Anglin (CEO/AUTHORIZED OFFICIAL) |
Authorized Official Contact | 4174483626 |
Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
Mailing Address | Practice Location Address |
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800 S. Ash Street Nevada MO 64772-3223 Ph: (417) 667-3355 | 320 N. 14th Street Rich Hill MO 64779-2145 Ph: (417) 395-2150 |
NPI Number | 1417049511 |
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Provider Enumeration Date | 09/28/2006 |
Last Update Date | 12/19/2022 |
Medicare PECOS PAC ID | 9830095280 |
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Medicare Enrollment ID | O20071204000194 |
Identifier | Type | State | Issuer |
---|---|---|---|
1417049511 | NPI | - | NPPES |
21902019 | Other | MO | BLUE CROSS PROVIDER NUMBE |
597677509 | Medicaid | MO |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
261QR1300X | Clinic/center - Rural Health | 19043 (Missouri) | Primary |