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1100 E Outer Rd S Ste 4 Canton MO 63435-1702 | |
(573) 288-5949 | |
(573) 288-5755 |
Full Name | |
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Speciality | Clinic/Center |
Location | 1100 E Outer Rd S Ste 4, Canton, Missouri |
Authorized Official Name and Position | Dan Evans (CEO) |
Authorized Official Contact | 2172226550 |
Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
Mailing Address | Practice Location Address |
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1025 Maine St Quincy IL 62301-4038 Ph: (217) 222-6550 | 1100 E Outer Rd S Ste 4 Canton MO 63435-1702 Ph: (573) 288-5949 |
NPI Number | 1902870439 |
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Provider Enumeration Date | 02/13/2006 |
Last Update Date | 12/20/2021 |
Medicare PECOS PAC ID | 0749192375 |
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Medicare Enrollment ID | O20101105000872 |
Identifier | Type | State | Issuer |
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1902870439 | NPI | - | NPPES |
Taxonomy | Type | License (State) | Status |
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261QR1300X | Clinic/center - Rural Health | (* (Not Available)) | Primary |