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1905 West 19th Street Mountain Grove MO 65711 | |
(417) 926-1770 | |
(417) 926-1785 |
Full Name | |
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Speciality | Clinic/Center |
Location | 1905 West 19th Street, Mountain Grove, 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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1905 West 19th Street Mountain Grove MO 65711 Ph: (417) 926-1770 | 1905 West 19th Street Mountain Grove MO 65711 Ph: (417) 926-1770 |
NPI Number | 1265754501 |
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Provider Enumeration Date | 02/26/2010 |
Last Update Date | 10/31/2016 |
Medicare PECOS PAC ID | 9436041696 |
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Medicare Enrollment ID | O20100505000258 |
Identifier | Type | State | Issuer |
---|---|---|---|
1265754501 | NPI | - | NPPES |
1265754501 | Medicaid | MO | |
1285957001 | Medicaid | MO | |
26D2006074 | Other | MO | CLIA |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
261QR1300X | Clinic/center - Rural Health | (* (Not Available)) | Primary |
Mountain Grove Medical And Laser Center Inc Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 601 N Busch Ave, Mountain Grove, MO 65711 Phone: 417-926-6643 Fax: 417-926-6317 | |