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425 N Galloway Rd Vandalia MO 63382-1259 | |
(573) 754-5531 | |
Not Available |
Full Name | |
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Speciality | Clinic/Center |
Location | 425 N Galloway Rd, Vandalia, Missouri |
Authorized Official Name and Position | Justin Selle (CEO) |
Authorized Official Contact | 5737545531 |
Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
Mailing Address | Practice Location Address |
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2305 Georgia St Louisiana MO 63353-2559 Ph: () - | 425 N Galloway Rd Vandalia MO 63382-1259 Ph: (573) 754-5531 |
NPI Number | 1033578588 |
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Provider Enumeration Date | 02/12/2016 |
Last Update Date | 05/18/2017 |
Medicare PECOS PAC ID | 8123015518 |
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Medicare Enrollment ID | O20160512001234 |
Identifier | Type | State | Issuer |
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1033578588 | NPI | - | NPPES |
Taxonomy | Type | License (State) | Status |
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207Q00000X | Family Medicine | (* (Not Available)) | Secondary |
261QR1300X | Clinic/center - Rural Health | (* (Not Available)) | Primary |