| |
109 N Broadway South West City MO 64863-0160 | |
(417) 762-3287 | |
(417) 762-3255 |
Full Name | |
---|---|
Speciality | Family Medicine |
Location | 109 N Broadway, South West City, Missouri |
Authorized Official Name and Position | Vicki Plumlee (DIRECTOR OF CLINICS) |
Authorized Official Contact | 4177623287 |
Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
Mailing Address | Practice Location Address |
---|---|
Po Box 160 South West City MO 64863-0160 Ph: (417) 762-3287 | 109 N Broadway South West City MO 64863-0160 Ph: (417) 762-3287 |
NPI Number | 1295865624 |
---|---|
Provider Enumeration Date | 03/06/2007 |
Last Update Date | 04/15/2014 |
Identifier | Type | State | Issuer |
---|---|---|---|
1295865624 | NPI | - | NPPES |
506813815 | Medicaid | MO |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
207Q00000X | Family Medicine | (* (Not Available)) | Primary |
Sgoh Acquisition, Inc. Primary Care Clinic Medicare: Medicare Enrolled Practice Location: 109 N Broadway St, South West City, MO 64863 Phone: 417-762-3287 |