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108 S Hickory St Mount Vernon MO 65712-1407 | |
(417) 466-4110 | |
(417) 466-4255 |
Full Name | |
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Speciality | Clinic/Center |
Location | 108 S Hickory St, Mount Vernon, Missouri |
Authorized Official Name and Position | Paul G Taylor (ADMINISTRATOR CEO) |
Authorized Official Contact | 4178374000 |
Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
Mailing Address | Practice Location Address |
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108 S Hickory St Mount Vernon MO 65712-1407 Ph: (417) 466-4110 | 108 S Hickory St Mount Vernon MO 65712-1407 Ph: (417) 466-4110 |
NPI Number | 1568502631 |
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Provider Enumeration Date | 02/07/2007 |
Last Update Date | 10/27/2014 |
Medicare PECOS PAC ID | 5092616276 |
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Medicare Enrollment ID | O20150205000659 |
Identifier | Type | State | Issuer |
---|---|---|---|
1568502631 | NPI | - | NPPES |
591234208 | Medicaid | MO |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
261QR1300X | Clinic/center - Rural Health | (* (Not Available)) | Primary |
Oncare Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 918 Sunshine Dr, Mount Vernon, MO 65712 Phone: 417-553-9583 Fax: 417-553-9585 | |