Full Name | |
---|---|
Speciality | Clinic/Center |
Location | 91 Troy Sq, Troy, Missouri |
Authorized Official Name and Position | Teresa Porter (CREDENTIALING MANAGER) |
Authorized Official Contact | 6608908156 |
Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
Mailing Address | Practice Location Address |
---|---|
1800 Community Clinton MO 64735-8804 Ph: (660) 890-8186 | 91 Troy Sq Troy MO 63379-3227 Ph: (844) 853-8937 |
NPI Number | 1073062592 |
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Provider Enumeration Date | 09/26/2016 |
Last Update Date | 03/01/2022 |
Medicare PECOS PAC ID | 1951206754 |
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Medicare Enrollment ID | O20161129001301 |
Identifier | Type | State | Issuer |
---|---|---|---|
1073062592 | NPI | - | NPPES |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
261QF0400X | Clinic/center - Federally Qualified Health Center (fqhc) | (* (Not Available)) | Primary |
Lewis Meyerson, Md Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 104 Sarah Ann Blvd, Troy, MO 63379 Phone: 636-528-5281 Fax: 636-462-2637 | |