Full Name | |
---|---|
Speciality | Clinic/Center |
Location | 125 Main St, Noel, Missouri |
Authorized Official Name and Position | Paul G Taylor (CEO) |
Authorized Official Contact | 4178374090 |
Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
Mailing Address | Practice Location Address |
---|---|
125 Main St Noel MO 64854-9124 Ph: (417) 475-6151 | 125 Main St Noel MO 64854-9124 Ph: (417) 475-6151 |
NPI Number | 1386985521 |
---|---|
Provider Enumeration Date | 03/13/2013 |
Last Update Date | 07/09/2013 |
Medicare PECOS PAC ID | 5092616276 |
---|---|
Medicare Enrollment ID | O20140409000194 |
Identifier | Type | State | Issuer |
---|---|---|---|
1386985521 | NPI | - | NPPES |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
261QR1300X | Clinic/center - Rural Health | 1454-13 (Missouri) | Primary |