| Sikeston High School Clinic | |
|
200 Pine St Sikeston MO 63801-3258 | |
| (573) 472-8850 | |
| Not Available |
| Full Name | Sikeston High School Clinic |
|---|---|
| Speciality | Clinic/Center |
| Location | 200 Pine St, Sikeston, Missouri |
| Authorized Official Name and Position | Sara Deane (CHIEF FINANCIAL OFFICER) |
| Authorized Official Contact | 5733132500 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Sikeston High School Clinic 6738 State Highway 77 Benton MO 63736-8238 Ph: (573) 313-2500 | Sikeston High School Clinic 200 Pine St Sikeston MO 63801-3258 Ph: (573) 472-8850 |
| NPI Number | 1770129199 |
|---|---|
| Provider Enumeration Date | 11/20/2019 |
| Last Update Date | 04/14/2020 |
| Medicare PECOS PAC ID | 6507818044 |
|---|---|
| Medicare Enrollment ID | O20191204000403 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1770129199 | NPI | - | NPPES |
| 500077980 | Medicaid | MO |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QF0400X | Clinic/center - Federally Qualified Health Center (fqhc) | (* (Not Available)) | Primary |
| 261QM1300X | Clinic/center - Multi-specialty | (* (Not Available)) | Secondary |
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