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Rr 3 Box 3707 Thayer MO 65791-9306 | |
(417) 264-2990 | |
(417) 264-2993 |
Full Name | |
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Speciality | Clinic/Center |
Location | Rr 3 Box 3707, Thayer, Missouri |
Authorized Official Name and Position | Patricia J Richards (CEO) |
Authorized Official Contact | 4172558464 |
Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
Mailing Address | Practice Location Address |
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1137 Independence Dr West Plains MO 65775-4221 Ph: (417) 255-8464 | Rr 3 Box 3707 Thayer MO 65791-9306 Ph: (417) 264-2990 |
NPI Number | 1164488680 |
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Provider Enumeration Date | 04/24/2006 |
Last Update Date | 01/15/2015 |
Medicare PECOS PAC ID | 6103734058 |
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Medicare Enrollment ID | O20050216000619 |
Identifier | Type | State | Issuer |
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1164488680 | NPI | - | NPPES |
Taxonomy | Type | License (State) | Status |
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261QF0400X | Clinic/center - Federally Qualified Health Center (fqhc) | (* (Not Available)) | Primary |