| Otto Bean Medical Center | |
|
500 Russell St Kennett MO 63857-2102 | |
| (573) 717-1332 | |
| (573) 717-1335 |
| Full Name | Otto Bean Medical Center |
|---|---|
| Speciality | Clinic/Center |
| Location | 500 Russell St, Kennett, Missouri |
| Authorized Official Name and Position | Sara Deane (CHIEF FINANCIAL OFFICER) |
| Authorized Official Contact | 5733132500 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Otto Bean Medical Center 6738 State Highway 77 Benton MO 63736-8238 Ph: (573) 313-2500 | Otto Bean Medical Center 500 Russell St Kennett MO 63857-2102 Ph: (573) 717-1332 |
| NPI Number | 1710108766 |
|---|---|
| Provider Enumeration Date | 05/01/2007 |
| Last Update Date | 04/14/2020 |
| Medicare PECOS PAC ID | 6507818044 |
|---|---|
| Medicare Enrollment ID | O20070301000227 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1710108766 | NPI | - | NPPES |
| 500704036 | Medicaid | MO |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QF0400X | Clinic/center - Federally Qualified Health Center (fqhc) | (* (Not Available)) | Primary |
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