Full Name | |
---|---|
Speciality | Clinic/Center |
Location | 16 W. 4th St., Grant City, Missouri |
Authorized Official Name and Position | Dwight Carvell (DIRECTOR OF REIMBURSEMENT) |
Authorized Official Contact | 8162730437 |
Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
Mailing Address | Practice Location Address |
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16 W. 4th St. Po Box 187 Grant City MO 64456 Ph: (660) 564-3322 | 16 W. 4th St. Grant City MO 64456 Ph: (660) 564-3322 |
NPI Number | 1053452623 |
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Provider Enumeration Date | 02/08/2007 |
Last Update Date | 09/12/2024 |
Medicare PECOS PAC ID | 5496641896 |
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Medicare Enrollment ID | O20150713000474 |
Identifier | Type | State | Issuer |
---|---|---|---|
1053452623 | NPI | - | NPPES |
505708305 | Medicaid | MO |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
261QP2300X | Clinic/center - Primary Care | (* (Not Available)) | Secondary |
261QR1300X | Clinic/center - Rural Health | (* (Not Available)) | Primary |