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100 Highway 28 E Belle MO 65013-3405 | |
| (573) 859-3775 | |
| (573) 859-3997 |
| Full Name | |
|---|---|
| Speciality | Clinic/Center |
| Location | 100 Highway 28 E, Belle, Missouri |
| Authorized Official Name and Position | James T Stratton (CFO) |
| Authorized Official Contact | 5736813129 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
Po Box 1027 Jefferson City MO 65102-1027 Ph: (573) 681-3767 | 100 Highway 28 E Belle MO 65013-3405 Ph: (573) 859-3775 |
| NPI Number | 1659327393 |
|---|---|
| Provider Enumeration Date | 05/25/2006 |
| Last Update Date | 06/20/2022 |
| Medicare PECOS PAC ID | 8921917352 |
|---|---|
| Medicare Enrollment ID | O20050322000373 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1659327393 | NPI | - | NPPES |
| 503825606 | Medicaid | MO |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261Q00000X | Clinic/center | (* (Not Available)) | Secondary |
| 261QR1300X | Clinic/center - Rural Health | (* (Not Available)) | Primary |
| Provider Name | Shannon Wright |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1619033404 PECOS PAC ID: 2668579871 Enrollment ID: I20070523000456 |
| Provider Name | Tricia D Temmen |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1285974774 PECOS PAC ID: 2769627926 Enrollment ID: I20130319000066 |
| Provider Name | Joanna L Younker |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1114278124 PECOS PAC ID: 1254648025 Enrollment ID: I20170928000503 |
| Provider Name | Taylor Joseph Allen |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1225514003 PECOS PAC ID: 6507105244 Enrollment ID: I20210820002663 |