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308 S Church St Fayette MO 65248-1243 | |
(660) 248-2217 | |
(660) 248-3450 |
Full Name | |
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Speciality | Clinic/center - Multi-specialty |
Location | 308 S Church St, Fayette, Missouri |
Authorized Official Name and Position | Jeff Crawford (ASSISTANT DIRECTOR) |
Authorized Official Contact | 5738827767 |
Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
Mailing Address | Practice Location Address |
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Po Box 7687 Columbia MO 65205-7687 Ph: (573) 882-8612 | 308 S Church St Fayette MO 65248-1243 Ph: (660) 248-2217 |
NPI Number | 1457422404 |
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Provider Enumeration Date | 11/13/2006 |
Last Update Date | 08/22/2020 |
Identifier | Type | State | Issuer |
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1457422404 | NPI | - | NPPES |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
261QM1300X | Clinic/center - Multi-specialty | (* (Not Available)) | Primary |