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425 N Galloway Rd Vandalia MO 63382-1259 | |
(573) 594-2111 | |
Not Available |
Full Name | |
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Speciality | Family Medicine |
Location | 425 N Galloway Rd, Vandalia, Missouri |
Authorized Official Name and Position | Justin Selle (CEO) |
Authorized Official Contact | 5737545531 |
Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
Mailing Address | Practice Location Address |
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2305 Georgia St Louisiana MO 63353-2559 Ph: (573) 754-5531 | 425 N Galloway Rd Vandalia MO 63382-1259 Ph: (573) 594-2111 |
NPI Number | 1891201331 |
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Provider Enumeration Date | 12/20/2017 |
Last Update Date | 12/20/2017 |
Identifier | Type | State | Issuer |
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1891201331 | NPI | - | NPPES |
Taxonomy | Type | License (State) | Status |
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207Q00000X | Family Medicine | (* (Not Available)) | Primary |