| |
401 E Walnut St Thayer MO 65791-1533 | |
(417) 255-8464 | |
(417) 255-9732 |
Full Name | |
---|---|
Speciality | Clinic/center - Federally Qualified Health Center (fqhc) |
Location | 401 E Walnut St, Thayer, Missouri |
Authorized Official Name and Position | Bryan Adcock (CEO) |
Authorized Official Contact | 4172558464 |
Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
Mailing Address | Practice Location Address |
---|---|
1137 Independence Dr West Plains MO 65775-4221 Ph: (417) 255-8464 | 401 E Walnut St Thayer MO 65791-1533 Ph: (417) 255-8464 |
NPI Number | 1245874510 |
---|---|
Provider Enumeration Date | 10/30/2019 |
Last Update Date | 02/05/2020 |
Identifier | Type | State | Issuer |
---|---|---|---|
1245874510 | NPI | - | NPPES |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
261QF0400X | Clinic/center - Federally Qualified Health Center (fqhc) | (* (Not Available)) | Primary |