Steadfast Spine And Sports Medicine | |
1190 Jefferson St Ste 203 Washington MO 63090-4443 | |
(636) 283-0328 | |
Not Available |
Full Name | Steadfast Spine And Sports Medicine |
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Speciality | Clinic/Center |
Location | 1190 Jefferson St Ste 203, Washington, Missouri |
Authorized Official Name and Position | Justin Cosgrove (OWNER) |
Authorized Official Contact | 6363594663 |
Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
Mailing Address | Practice Location Address |
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Steadfast Spine And Sports Medicine 1190 Jefferson St Ste 203 Washington MO 63090-4443 Ph: (636) 283-0328 | Steadfast Spine And Sports Medicine 1190 Jefferson St Ste 203 Washington MO 63090-4443 Ph: (636) 283-0328 |
NPI Number | 1952181216 |
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Provider Enumeration Date | 10/04/2023 |
Last Update Date | 10/04/2023 |
Medicare PECOS PAC ID | 8628424561 |
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Medicare Enrollment ID | O20231027002587 |
Identifier | Type | State | Issuer |
---|---|---|---|
1952181216 | NPI | - | NPPES |
Taxonomy | Type | License (State) | Status |
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261Q00000X | Clinic/center | (* (Not Available)) | Primary |
Provider Name | Justin Anthony Cosgrove |
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Provider Type | Practitioner - Chiropractic |
Provider Identifiers | NPI Number: 1245010743 PECOS PAC ID: 9537515473 Enrollment ID: I20231027002662 |
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