Full Name | |
---|---|
Speciality | Clinic/Center |
Location | 120 Sw 2nd Avenue, Ava, Missouri |
Authorized Official Name and Position | Kenneth H Dugan (VICE PRESIDENT) |
Authorized Official Contact | 4179243066 |
Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
Mailing Address | Practice Location Address |
---|---|
Po Box 108 Mansfield MO 65704-0108 Ph: (417) 924-3066 | 120 Sw 2nd Avenue Ava MO 65608 Ph: (417) 683-6790 |
NPI Number | 1285687509 |
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Provider Enumeration Date | 05/18/2006 |
Last Update Date | 04/21/2011 |
Medicare PECOS PAC ID | 3971413360 |
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Medicare Enrollment ID | O20060914000104 |
Identifier | Type | State | Issuer |
---|---|---|---|
1285687509 | NPI | - | NPPES |
508809506 | Medicaid | MO |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
261QR1300X | Clinic/center - Rural Health | (* (Not Available)) | Primary |
Douglas County Health Department Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 603 Nw 12th St, Building C, Ava, MO 65608 Phone: 417-683-4174 Fax: 417-683-4111 | |