| Tcmh Outpatient Clinic | |
|
1333 S Sam Houston Blvd Ste A Houston MO 65483 | |
| (417) 967-1319 | |
| (417) 967-3764 |
| Full Name | Tcmh Outpatient Clinic |
|---|---|
| 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 |
|---|---|
| Tcmh Outpatient Clinic 1333 S Sam Houston Blvd Ste A Houston MO 65483-2046 Ph: (417) 967-1319 | Tcmh Outpatient Clinic 1333 S Sam Houston Blvd Ste A Houston MO 65483 Ph: (417) 967-1319 |
| NPI Number | 1164921300 |
|---|---|
| Provider Enumeration Date | 02/02/2018 |
| Last Update Date | 07/18/2018 |
| Medicare PECOS PAC ID | 9436041696 |
|---|---|
| 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 |
|---|---|
| Provider Type | Practitioner - Pain Management |
| Provider Identifiers | NPI Number: 1841309952 PECOS PAC ID: 8123177268 Enrollment ID: I20100825000078 |
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