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1333 S Sam Houston Blvd Ste A Houston MO 65483 | |
(417) 967-1319 | |
(417) 967-3764 |
Full Name | |
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Speciality | Clinic/Center |
Location | 1333 S Sam Houston Blvd Ste A, Houston, Missouri |
Authorized Official Name and Position | Linda J Pamperien (CFO) |
Authorized Official Contact | 4179671255 |
Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
Mailing Address | Practice Location Address |
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1333 S Sam Houston Blvd Ste A Houston MO 65483-2046 Ph: (417) 967-1319 | 1333 S Sam Houston Blvd Ste A Houston MO 65483 Ph: (417) 967-1319 |
NPI Number | 1164921300 |
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Provider Enumeration Date | 02/02/2018 |
Last Update Date | 07/18/2018 |
Medicare PECOS PAC ID | 9436041696 |
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Medicare Enrollment ID | O20180302000181 |
Identifier | Type | State | Issuer |
---|---|---|---|
1164921300 | NPI | - | NPPES |
500050927 | Medicaid | MO | |
MA6957 | Other | MO | MEDICARE PART B |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
261QM1300X | Clinic/center - Multi-specialty | (* (Not Available)) | Primary |
Provider Name | Richard E Moore |
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Provider Type | Practitioner - Pain Management |
Provider Identifiers | NPI Number: 1841309952 PECOS PAC ID: 8123177268 Enrollment ID: I20100825000078 |
Hometown Healthcare And Wellness Center, Inc. Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 107 E Pine St, Houston, MO 65483 Phone: 417-967-0537 Fax: 417-967-0542 | |
Dale Family Medicine Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 1340 S Sam Houston Blvd, Houston, MO 65483 Phone: 417-967-3755 Fax: 417-967-2630 | |