Tcmh Family Clinic - Licking | |
139 W Highway 32 Licking MO 65542-9898 | |
(573) 674-3011 | |
(573) 674-4765 |
Full Name | Tcmh Family Clinic - Licking |
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Speciality | Clinic/Center |
Location | 139 W Highway 32, Licking, Missouri |
Authorized Official Name and Position | Linda J. Pamperien (CHIEF FINANCIAL OFFICER) |
Authorized Official Contact | 4179673311 |
Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
Mailing Address | Practice Location Address |
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Tcmh Family Clinic - Licking 139 W Highway 32 Licking MO 65542-9898 Ph: (573) 674-3011 | Tcmh Family Clinic - Licking 139 W Highway 32 Licking MO 65542-9898 Ph: (573) 674-3011 |
NPI Number | 1235178930 |
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Provider Enumeration Date | 06/06/2006 |
Last Update Date | 07/12/2024 |
Medicare PECOS PAC ID | 9436041696 |
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Medicare Enrollment ID | O20041020000359 |
Identifier | Type | State | Issuer |
---|---|---|---|
1235178930 | NPI | - | NPPES |
26D0679044 | Other | MO | CLIA |
505288902 | Medicaid | MO |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
261QP2300X | Clinic/center - Primary Care | (* (Not Available)) | Primary |
Provider Name | Jessica Renee King |
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Provider Type | Practitioner - Family Practice |
Provider Identifiers | NPI Number: 1649434200 PECOS PAC ID: 6608907977 Enrollment ID: I20100630000472 |
Provider Name | Douglas A Crase |
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Provider Type | Practitioner - Family Practice |
Provider Identifiers | NPI Number: 1295115236 PECOS PAC ID: 6002120110 Enrollment ID: I20180626001861 |
Provider Name | Samantha D Welch |
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Provider Type | Practitioner - Nurse Practitioner |
Provider Identifiers | NPI Number: 1932734092 PECOS PAC ID: 7517397573 Enrollment ID: I20200415002855 |
Provider Name | Latricia Juneau |
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Provider Type | Practitioner - Nurse Practitioner |
Provider Identifiers | NPI Number: 1770171514 PECOS PAC ID: 1850705773 Enrollment ID: I20210203002783 |
Provider Name | John R Carr |
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Provider Type | Practitioner - Internal Medicine |
Provider Identifiers | NPI Number: 1154816858 PECOS PAC ID: 5698027837 Enrollment ID: I20210805001683 |
Provider Name | Stephanie A Thurman |
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Provider Type | Practitioner - Nurse Practitioner |
Provider Identifiers | NPI Number: 1043966724 PECOS PAC ID: 5193193571 Enrollment ID: I20221115003060 |
Provider Name | William R Errico |
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Provider Type | Practitioner - Family Practice |
Provider Identifiers | NPI Number: 1366529570 PECOS PAC ID: 9830222082 Enrollment ID: I20230801002516 |
Tcmh Family Clinic - Licking Primary Care Clinic Medicare: Medicare Enrolled Practice Location: 139 W Highway 32, Licking, MO 65542 Phone: 573-674-3011 Fax: 573-674-4765 | |
Douglas County Public Health Services Group, Inc. Primary Care Clinic Medicare: Medicare Enrolled Practice Location: 135 College Ave., Licking, MO 65542 Phone: 417-683-4831 |