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5001 Lake Ave Saint Joseph MO 64504-1170 | |
(816) 238-7788 | |
(816) 238-9285 |
Full Name | |
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Speciality | Clinic/Center |
Location | 5001 Lake Ave, Saint Joseph, Missouri |
Authorized Official Name and Position | Matt Younger (CEO) |
Authorized Official Contact | 8162326818 |
Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
Mailing Address | Practice Location Address |
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5001 Lake Ave Saint Joseph MO 64504-1170 Ph: (816) 238-7788 | 5001 Lake Ave Saint Joseph MO 64504-1170 Ph: (816) 238-7788 |
NPI Number | 1194846550 |
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Provider Enumeration Date | 04/03/2007 |
Last Update Date | 11/10/2021 |
Medicare PECOS PAC ID | 7113835174 |
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Medicare Enrollment ID | O20040421001394 |
Identifier | Type | State | Issuer |
---|---|---|---|
1194846550 | NPI | - | NPPES |
509384202 | Medicaid | MO |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
207Q00000X | Family Medicine | (* (Not Available)) | Secondary |
261QF0400X | Clinic/center - Federally Qualified Health Center (fqhc) | (* (Not Available)) | Primary |