| Sweeten Medical Clinic | |
|
1355 Rocketdyne Rd Neosho MO 64850-3106 | |
| (417) 451-7425 | |
| (417) 451-7455 |
| Full Name | Sweeten Medical Clinic |
|---|---|
| Speciality | Internal Medicine |
| Location | 1355 Rocketdyne Rd, Neosho, Missouri |
| Authorized Official Name and Position | Tina Rene Sweeten (MANAGER) |
| Authorized Official Contact | 4175406798 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Sweeten Medical Clinic Po Box 4725 Joplin MO 64803-4725 Ph: (417) 451-7425 | Sweeten Medical Clinic 1355 Rocketdyne Rd Neosho MO 64850-3106 Ph: (417) 451-7425 |
| NPI Number | 1407052616 |
|---|---|
| Provider Enumeration Date | 06/25/2007 |
| Last Update Date | 04/25/2017 |
| Medicare PECOS PAC ID | 0941275911 |
|---|---|
| Medicare Enrollment ID | O20071023000141 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1407052616 | NPI | - | NPPES |
| 000015453 | Other | MO | MEDICARE PTAN |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207R00000X | Internal Medicine | 12749 (Oklahoma) | Secondary |
| 207R00000X | Internal Medicine | 2007032918 (Missouri) | Primary |
| Provider Name | Angela Williams |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1700392537 PECOS PAC ID: 4385904416 Enrollment ID: I20180208002969 |
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