| Tcmh - Mountain Grove Clinic | |
|
1905 West 19th Street Mountain Grove MO 65711 | |
| (417) 926-1770 | |
| (417) 926-1785 |
| Full Name | Tcmh - Mountain Grove Clinic |
|---|---|
| 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 |
|---|---|
| Tcmh - Mountain Grove Clinic 1905 West 19th Street Mountain Grove MO 65711 Ph: (417) 926-1770 | Tcmh - Mountain Grove Clinic 1905 West 19th Street Mountain Grove MO 65711 Ph: (417) 926-1770 |
| NPI Number | 1265754501 |
|---|---|
| Provider Enumeration Date | 02/26/2010 |
| Last Update Date | 10/31/2016 |
| Medicare PECOS PAC ID | 9436041696 |
|---|---|
| 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 |
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