| Katy Trail - Marshall School | |
|
313 E Eastwood St Marshall MO 65340-1413 | |
| (660) 886-7100 | |
| Not Available |
| Full Name | Katy Trail - Marshall School |
|---|---|
| Speciality | Clinic/Center |
| Location | 313 E Eastwood St, Marshall, Missouri |
| Authorized Official Name and Position | Michael Waller (CEO) |
| Authorized Official Contact | 5733782349 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Katy Trail - Marshall School 821 Westwood Dr Sedalia MO 65301-2102 Ph: (660) 826-4774 | Katy Trail - Marshall School 313 E Eastwood St Marshall MO 65340-1413 Ph: (660) 886-7100 |
| NPI Number | 1134695372 |
|---|---|
| Provider Enumeration Date | 10/15/2018 |
| Last Update Date | 02/21/2024 |
| Medicare PECOS PAC ID | 8224926092 |
|---|---|
| Medicare Enrollment ID | O20200226001375 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1134695372 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QF0400X | Clinic/center - Federally Qualified Health Center (fqhc) | (* (Not Available)) | Primary |
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