| |
11863 State Highway 13 Kimberling City MO 65686 | |
(417) 739-1995 | |
Not Available |
Full Name | |
---|---|
Speciality | Clinic/Center |
Location | 11863 State Highway 13, Kimberling City, Missouri |
Authorized Official Name and Position | Robert Marsh (EXECUTIVE DIRECTOR) |
Authorized Official Contact | 4177672273 |
Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
Mailing Address | Practice Location Address |
---|---|
1059 Barton Dr Fordland MO 65652-7350 Ph: (417) 767-2273 | 11863 State Highway 13 Kimberling City MO 65686 Ph: (417) 739-1995 |
NPI Number | 1639421365 |
---|---|
Provider Enumeration Date | 10/04/2012 |
Last Update Date | 02/01/2016 |
Medicare PECOS PAC ID | 5597794552 |
---|---|
Medicare Enrollment ID | O20151014001752 |
Identifier | Type | State | Issuer |
---|---|---|---|
1639421365 | NPI | - | NPPES |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
261QF0400X | Clinic/center - Federally Qualified Health Center (fqhc) | 26-1102 (Missouri) | Primary |