| Southeast Health On Wheels Mobile Van | |
|
700 N Douglass St Malden MO 63863-1510 | |
| (573) 748-7701 | |
| (573) 748-2554 |
| Full Name | Southeast Health On Wheels Mobile Van |
|---|---|
| Speciality | Clinic/center - Federally Qualified Health Center (fqhc) |
| Location | 700 N Douglass St, Malden, Missouri |
| Authorized Official Name and Position | Cheryl A White (CEO) |
| Authorized Official Contact | 5737482404 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Southeast Health On Wheels Mobile Van 420 Line St P.o. Box 400 New Madrid MO 63869-1734 Ph: (573) 748-2404 | Southeast Health On Wheels Mobile Van 700 N Douglass St Malden MO 63863-1510 Ph: (573) 748-7701 |
| NPI Number | 1720209794 |
|---|---|
| Provider Enumeration Date | 05/01/2007 |
| Last Update Date | 05/02/2013 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1720209794 | NPI | - | NPPES |
| 500704028 | Medicaid | MO | |
| 000010626 | Other | MO | GROUP PTAN |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QF0400X | Clinic/center - Federally Qualified Health Center (fqhc) | (* (Not Available)) | Primary |
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Msh Malden Clinic Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 1707 N Doulgas, Malden, MO 63863 Phone: 573-276-6488 | |
Daeoc Family Planning Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 1 Town Sq, Malden, MO 63863 Phone: 573-276-6090 Fax: 573-276-6108 | |
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