Full Name | |
---|---|
Speciality | Clinic/center - Multi-specialty |
Location | 500 Main Street, Cabool, Missouri |
Authorized Official Name and Position | Linda J. Pamperien (CHIEF FINANCIAL OFFICER) |
Authorized Official Contact | 4179673311 |
Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
Mailing Address | Practice Location Address |
---|---|
1337 S Sam Houston Blvd Houston MO 65483-2046 Ph: (417) 967-5435 | 500 Main Street Cabool MO 65689 Ph: (417) 962-3015 |
NPI Number | 1518904531 |
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Provider Enumeration Date | 05/31/2006 |
Last Update Date | 08/20/2008 |
Identifier | Type | State | Issuer |
---|---|---|---|
1518904531 | NPI | - | NPPES |
509319208 | Medicaid | MO | |
26D1006457 | Other | MO | CLIA |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
261QM1300X | Clinic/center - Multi-specialty | (* (Not Available)) | Primary |
Douglas County Public Health Services Group, Inc. Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 2001 Dys Dr, Cabool, MO 65689 Phone: 417-962-4344 | |