| Katy Trail Community Health | |
|
41569 Ivy Bend Rd Stover MO 65078-2177 | |
| (877) 733-5824 | |
| (888) 979-8868 |
| Full Name | Katy Trail Community Health |
|---|---|
| Speciality | Clinic/Center |
| Location | 41569 Ivy Bend Rd, Stover, Missouri |
| Authorized Official Name and Position | Michael Waller (CEO) |
| Authorized Official Contact | 6608264774 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Katy Trail Community Health 821 Westwood Dr Sedalia MO 65301-2102 Ph: (660) 826-4774 | Katy Trail Community Health 41569 Ivy Bend Rd Stover MO 65078-2177 Ph: (877) 733-5824 |
| NPI Number | 1942841903 |
|---|---|
| Provider Enumeration Date | 10/01/2019 |
| Last Update Date | 02/21/2024 |
| Medicare PECOS PAC ID | 8224926092 |
|---|---|
| Medicare Enrollment ID | O20200513001649 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1942841903 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QF0400X | Clinic/center - Federally Qualified Health Center (fqhc) | (* (Not Available)) | Primary |
Capital Region Medical Clinic-stover Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 2nd Street And Oak, Stover, MO 65078 Phone: 573-377-2313 Fax: 573-377-4243 | |
Katy Trail Community Health Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 701 N Oak St, Stover, MO 65078 Phone: 573-377-4295 Fax: 660-826-1300 |