| |
575 Pine Drive Sainte Genevieve MO 63670 | |
(573) 883-7424 | |
(573) 883-7426 |
Full Name | |
---|---|
Speciality | Clinic/Center |
Location | 575 Pine Drive, Sainte Genevieve, Missouri |
Authorized Official Name and Position | Amanda Wolk (BUSINESS OFFICE DIRECTOR) |
Authorized Official Contact | 5738837703 |
Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
Mailing Address | Practice Location Address |
---|---|
Po Box 366 Ste Genevieve MO 63670-0366 Ph: (573) 883-4477 | 575 Pine Drive Sainte Genevieve MO 63670 Ph: (573) 883-7424 |
NPI Number | 1770504557 |
---|---|
Provider Enumeration Date | 07/21/2006 |
Last Update Date | 01/13/2023 |
Medicare PECOS PAC ID | 3274432802 |
---|---|
Medicare Enrollment ID | O20040409000228 |
Identifier | Type | State | Issuer |
---|---|---|---|
1770504557 | NPI | - | NPPES |
CC8331 | Other | MO | RAILROAD MEDICARE |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
261QR1300X | Clinic/center - Rural Health | (Missouri) | Primary |