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101 South Main Rogersville MO 65742 | |
(417) 753-9404 | |
(417) 753-9137 |
Full Name | |
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Speciality | Clinic/Center |
Location | 101 South Main, Rogersville, Missouri |
Authorized Official Name and Position | Paul G Taylor (CEO ADMINISTRATOR) |
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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101 South Main Rogersville MO 65742 Ph: (417) 753-9404 | 101 South Main Rogersville MO 65742 Ph: (417) 753-9404 |
NPI Number | 1942335203 |
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Provider Enumeration Date | 02/23/2007 |
Last Update Date | 08/03/2012 |
Medicare PECOS PAC ID | 5092616276 |
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Medicare Enrollment ID | O20230627003164 |
Identifier | Type | State | Issuer |
---|---|---|---|
1942335203 | NPI | - | NPPES |
598387306 | Medicaid | MO |
Taxonomy | Type | License (State) | Status |
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261QR1300X | Clinic/center - Rural Health | (* (Not Available)) | Primary |