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1000 5th Ave Saint Joseph MO 64505-2111 | |
(816) 233-3338 | |
(813) 233-4777 |
Full Name | |
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Speciality | Clinic/Center |
Location | 1000 5th Ave, Saint Joseph, Missouri |
Authorized Official Name and Position | Matt Younger (CEO) |
Authorized Official Contact | 8162326818 |
Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
Mailing Address | Practice Location Address |
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Po Box 803886 Kansas City MO 64180-2631 Ph: (816) 271-8265 | 1000 5th Ave Saint Joseph MO 64505-2111 Ph: (816) 233-3338 |
NPI Number | 1396866737 |
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Provider Enumeration Date | 04/03/2007 |
Last Update Date | 01/06/2022 |
Medicare PECOS PAC ID | 7113835174 |
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Medicare Enrollment ID | O20040419001789 |
Identifier | Type | State | Issuer |
---|---|---|---|
1396866737 | NPI | - | NPPES |
509384608 | Medicaid | MO |
Taxonomy | Type | License (State) | Status |
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207Q00000X | Family Medicine | (* (Not Available)) | Secondary |
261QF0400X | Clinic/center - Federally Qualified Health Center (fqhc) | (* (Not Available)) | Primary |