| Wyaconda Medical Services | |
|
124 W Jefferson St Wyaconda MO 63474 | |
| (660) 479-5553 | |
| (660) 479-5520 |
| Full Name | Wyaconda Medical Services |
|---|---|
| Speciality | Clinic/Center |
| Location | 124 W Jefferson St, Wyaconda, Missouri |
| Authorized Official Name and Position | Randall W Tobler (ADMINISTRATOR) |
| Authorized Official Contact | 6604658511 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Wyaconda Medical Services 124 W Jefferson St P O Box 317 Wyaconda MO 63474 Ph: (660) 479-5553 | Wyaconda Medical Services 124 W Jefferson St Wyaconda MO 63474 Ph: (660) 479-5553 |
| NPI Number | 1528077534 |
|---|---|
| Provider Enumeration Date | 08/07/2006 |
| Last Update Date | 10/27/2014 |
| Medicare PECOS PAC ID | 8224940366 |
|---|---|
| Medicare Enrollment ID | O20080611000137 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1528077534 | NPI | - | NPPES |
| 599764305 | Medicaid | MO |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | (* (Not Available)) | Secondary |
| 261QR1300X | Clinic/center - Rural Health | (* (Not Available)) | Primary |
Scotland County Memorial Hospital Dba Wyaconda Medical Services Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 127 W Jefferson St, Wyaconda, MO 63474 Phone: 660-479-5553 Fax: 660-479-5520 |