| Southern Missouri Family Medicine, Llc | |
|
1625 Gibson St West Plains MO 65775-1873 | |
| (417) 256-3717 | |
| (417) 256-3738 |
| Full Name | Southern Missouri Family Medicine, Llc |
|---|---|
| Speciality | Clinic/center - Primary Care |
| Location | 1625 Gibson St, West Plains, Missouri |
| Authorized Official Name and Position | James E Thompson (OWNER) |
| Authorized Official Contact | 4172563717 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Southern Missouri Family Medicine, Llc 1402 N Kentucky Ave West Plains MO 65775-1822 Ph: (417) 256-3717 | Southern Missouri Family Medicine, Llc 1625 Gibson St West Plains MO 65775-1873 Ph: (417) 256-3717 |
| NPI Number | 1154584308 |
|---|---|
| Provider Enumeration Date | 07/08/2008 |
| Last Update Date | 03/17/2010 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1154584308 | NPI | - | NPPES |
| 202379046 | Medicaid | MO |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QP2300X | Clinic/center - Primary Care | R5G97 (Missouri) | Primary |
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Hometown Clinic At West Plains, Llc Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 1402 N Kentucky Ave, West Plains, MO 65775 Phone: 417-256-3717 | |
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