Full Name | |
---|---|
Speciality | Clinic/Center |
Location | 581 Commons Drive, Fulton, Missouri |
Authorized Official Name and Position | Jeanann Schimmel Early (DIRECTOR OF COMPLIANCE) |
Authorized Official Contact | 5735821234 |
Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
Mailing Address | Practice Location Address |
---|---|
340 Kelley Pkwy Mexico MO 65265-3811 Ph: (573) 581-1196 | 581 Commons Drive Fulton MO 65251 Ph: (573) 642-3215 |
NPI Number | 1174008023 |
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Provider Enumeration Date | 09/26/2018 |
Last Update Date | 12/12/2024 |
Medicare PECOS PAC ID | 5395659403 |
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Medicare Enrollment ID | O20190222002107 |
Identifier | Type | State | Issuer |
---|---|---|---|
1174008023 | NPI | - | NPPES |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
261QF0400X | Clinic/center - Federally Qualified Health Center (fqhc) | (* (Not Available)) | Primary |
Fulton Family Health Associates, P.c. Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 2613 Fairway Dr, Suite C, Fulton, MO 65251 Phone: 573-642-1990 Fax: 573-642-1866 | |
Jefferson City Medical Group, P.c. Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 350 Country Meadow Ln, Fulton, MO 65251 Phone: 736-344-8785 | |