| Physician Services Of Missouri Llc | |
|
1611 S Baltimore St Kirksville MO 63501-4536 | |
| (859) 514-5547 | |
| (859) 422-4907 |
| Full Name | Physician Services Of Missouri Llc |
|---|---|
| Speciality | Family Medicine |
| Location | 1611 S Baltimore St, Kirksville, Missouri |
| Authorized Official Name and Position | Casey Deloach (MANAGER) |
| Authorized Official Contact | 8888298550 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Physician Services Of Missouri Llc 989 Governors Ln Suite 160 Lexington KY 40513-1173 Ph: (859) 514-5547 | Physician Services Of Missouri Llc 1611 S Baltimore St Kirksville MO 63501-4536 Ph: (859) 514-5547 |
| NPI Number | 1164792032 |
|---|---|
| Provider Enumeration Date | 01/09/2012 |
| Last Update Date | 01/09/2012 |
| Medicare PECOS PAC ID | 5597091629 |
|---|---|
| Medicare Enrollment ID | O20190729000424 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1164792032 | NPI | - | NPPES |
| PHC059 | Other | MEDICARE PTAN |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | (* (Not Available)) | Primary |
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