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301 W 2nd St Jamesport MO 64648-8208 | |
(660) 684-6244 | |
(660) 684-6246 |
Full Name | |
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Speciality | General Practice |
Location | 301 W 2nd St, Jamesport, Missouri |
Authorized Official Name and Position | Gary W Jordan (CEO) |
Authorized Official Contact | 6603585700 |
Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
Mailing Address | Practice Location Address |
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189 Iowa Blvd Trenton MO 64683-8343 Ph: (660) 358-5750 | 301 W 2nd St Jamesport MO 64648-8208 Ph: (660) 684-6244 |
NPI Number | 1831202431 |
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Provider Enumeration Date | 08/16/2006 |
Last Update Date | 05/14/2014 |
Identifier | Type | State | Issuer |
---|---|---|---|
1831202431 | NPI | - | NPPES |
508190006 | Medicaid | MO |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
208D00000X | General Practice | DOR9350 (Missouri) | Primary |
363LF0000X | Nurse Practitioner - Family | 99778 (Missouri) | Secondary |