Full Name | |
---|---|
Speciality | Clinic/center - Primary Care |
Location | 100 Shepherds Lane, Alton, Missouri |
Authorized Official Name and Position | Beckie Dawn Combs (PRESIDENT) |
Authorized Official Contact | 4177787959 |
Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
Mailing Address | Practice Location Address |
---|---|
100 Shepherds Lane Po Box 429 Alton MO 65606 Ph: (417) 778-7959 | 100 Shepherds Lane Alton MO 65606 Ph: (417) 778-7959 |
NPI Number | 1891739033 |
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Provider Enumeration Date | 06/16/2006 |
Last Update Date | 07/11/2016 |
Identifier | Type | State | Issuer |
---|---|---|---|
1891739033 | NPI | - | NPPES |
265179200 | Medicaid | MO |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
261QP2300X | Clinic/center - Primary Care | 030781 (Missouri) | Primary |