| |
2642 State Route 76 Willow Springs MO 65793-8254 | |
(417) 469-0204 | |
(417) 469-3443 |
Full Name | |
---|---|
Speciality | Clinic/Center |
Location | 2642 State Route 76, Willow Springs, Missouri |
Authorized Official Name and Position | Sherry Miller (CHIEF FINANCIAL OFFICER) |
Authorized Official Contact | 4174690204 |
Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
Mailing Address | Practice Location Address |
---|---|
Po Box 309 Willow Springs MO 65793-0309 Ph: (417) 469-0204 | 2642 State Route 76 Willow Springs MO 65793-8254 Ph: (417) 469-0204 |
NPI Number | 1184625782 |
---|---|
Provider Enumeration Date | 08/03/2005 |
Last Update Date | 07/22/2011 |
Medicare PECOS PAC ID | 2062401466 |
---|---|
Medicare Enrollment ID | O20230126003075 |
Identifier | Type | State | Issuer |
---|---|---|---|
1184625782 | NPI | - | NPPES |
591474101 | Medicaid | MO |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
261QR1300X | Clinic/center - Rural Health | (* (Not Available)) | Primary |
Valley Medical Center P.c. Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 308 S Harris St, Willow Springs, MO 65793 Phone: 417-469-3175 Fax: 417-469-1274 | |