Full Name | |
---|---|
Speciality | Clinic/Center |
Location | 1050 W 10th St, Rolla, Missouri |
Authorized Official Name and Position | Jana Marie Cook (SR. VP/CFO) |
Authorized Official Contact | 5734587916 |
Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
Mailing Address | Practice Location Address |
---|---|
Po Box 579 Rolla MO 65402-0579 Ph: (573) 426-2182 | 1050 W 10th St Rolla MO 65401-2905 Ph: (573) 364-9000 |
NPI Number | 1366066037 |
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Provider Enumeration Date | 05/29/2020 |
Last Update Date | 02/01/2023 |
Medicare PECOS PAC ID | 2860391158 |
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Medicare Enrollment ID | O20230303002223 |
Identifier | Type | State | Issuer |
---|---|---|---|
1366066037 | NPI | - | NPPES |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
261QR1300X | Clinic/center - Rural Health | (* (Not Available)) | Primary |
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