| |
90 Gravel St Cassville MO 65625-1601 | |
(417) 847-6045 | |
(417) 847-6049 |
Full Name | |
---|---|
Speciality | Clinic/center - Rural Health |
Location | 90 Gravel St, Cassville, Missouri |
Authorized Official Name and Position | Donn E. Sorensen (CHIEF OPERATING OFFICER) |
Authorized Official Contact | 4178294264 |
Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
Mailing Address | Practice Location Address |
---|---|
Po Box 2580 Springfield MO 65801-2580 Ph: (417) 829-4620 | 90 Gravel St Cassville MO 65625-1601 Ph: (417) 847-6045 |
NPI Number | 1740316728 |
---|---|
Provider Enumeration Date | 02/26/2007 |
Last Update Date | 06/30/2008 |
Identifier | Type | State | Issuer |
---|---|---|---|
1740316728 | NPI | - | NPPES |
598833101 | Medicaid | MO |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
207Q00000X | Family Medicine | R4E21 (Missouri) | Secondary |
261QR1300X | Clinic/center - Rural Health | (Missouri) | Primary |
363A00000X | Physician Assistant | 104182 (Missouri) | Secondary |
Barry County Health Department Primary Care Clinic Medicare: Medicare Enrolled Practice Location: 65 Main St, Cassville, MO 65625 Phone: 417-847-2114 Fax: 417-847-2116 |