Full Name | |
---|---|
Speciality | Clinic/Center |
Location | 100 Medical Drive, Alton, Missouri |
Authorized Official Name and Position | Thomas W Keller (PRESIDENT AND CEO) |
Authorized Official Contact | 4172569111 |
Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
Mailing Address | Practice Location Address |
---|---|
Po Box 1100 West Plains MO 65775-1100 Ph: () - | 100 Medical Drive Alton MO 65606 Ph: (417) 778-7227 |
NPI Number | 1588791842 |
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Provider Enumeration Date | 02/27/2007 |
Last Update Date | 11/12/2020 |
Medicare PECOS PAC ID | 3870491863 |
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Medicare Enrollment ID | O20080130000696 |
Identifier | Type | State | Issuer |
---|---|---|---|
1588791842 | NPI | - | NPPES |
593965304 | Medicaid | MO |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
261QR1300X | Clinic/center - Rural Health | 17447 (Missouri) | Primary |