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1000 N Jefferson Street St. James MO 65559-1078 | |
(573) 265-8840 | |
(573) 265-8884 |
Full Name | |
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Speciality | Clinic/Center |
Location | 1000 N Jefferson Street, St. James, Missouri |
Authorized Official Name and Position | Jana Marie Cook (CFO/SR. VP) |
Authorized Official Contact | 5734587916 |
Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
Mailing Address | Practice Location Address |
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Po Box 579 Rolla MO 65402 Ph: (573) 426-2182 | 1000 N Jefferson Street St. James MO 65559-1078 Ph: (573) 265-8840 |
NPI Number | 1457799520 |
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Provider Enumeration Date | 06/11/2013 |
Last Update Date | 02/02/2023 |
Medicare PECOS PAC ID | 2860391158 |
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Medicare Enrollment ID | O20230303001691 |
Identifier | Type | State | Issuer |
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1457799520 | NPI | - | NPPES |
Taxonomy | Type | License (State) | Status |
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261QR1300X | Clinic/center - Rural Health | (* (Not Available)) | Primary |