| Keith Edward Segall, DO | |
|
111 Parkway, Vienna, MO 65582-8003 | |
| (573) 422-3360 | |
| (573) 422-3391 |
| Full Name | Keith Edward Segall |
|---|---|
| Gender | Male |
| Speciality | Family Medicine |
| Location | 111 Parkway, Vienna, Missouri |
| Accepts Medicare Assignments | Medicare enrolled and may accept medicare through third-party reassignment. May prescribe medicare part D drugs. |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1639245368 | NPI | - | NPPES |
| 0120039 | Other | UNITED HEALTHCARE | |
| 10048 | Other | MO | BLUE CROSS |
| 1904V1471 | Other | HEALTHCARE USA | |
| 257668 | Other | MO | HEALTHLINK |
| G00218 | Other | MO | MERCY HEALTH PLAN |
| 13680 | Other | GROUP HEALTH PLAN | |
| 247757602 | Medicaid | MO | |
| V410 | Other | MO | MISSOURI CARE |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | D0106518 (Missouri) | Primary |
| Entity Name | Regional Health Care Clinic Inc |
|---|---|
| Entity Type | Part B Supplier - Clinic/group Practice |
| Entity Identifiers | NPI Number: 1922057504 PECOS PAC ID: 8224926092 Enrollment ID: O20040304001212 |
| Entity Name | Jefferson City Medical Group Pc |
|---|---|
| Entity Type | Part B Supplier - Clinic/group Practice |
| Entity Identifiers | NPI Number: 1336189398 PECOS PAC ID: 1850371089 Enrollment ID: O20040908000924 |
| Entity Name | Capital Region Medical Center |
|---|---|
| Entity Type | Part B Supplier - Clinic/group Practice |
| Entity Identifiers | NPI Number: 1477980837 PECOS PAC ID: 4688573686 Enrollment ID: O20070323000507 |
| Entity Name | Regional Health Care Clinic Inc |
|---|---|
| Entity Type | Part B Supplier - Clinic/group Practice |
| Entity Identifiers | NPI Number: 1053694422 PECOS PAC ID: 8224926092 Enrollment ID: O20111201000035 |
| Mailing Address | Practice Location Address |
|---|---|
| Keith Edward Segall, DO 111 Parkway, Vienna, MO 65582-8003 Ph: (573) 422-3360 | Keith Edward Segall, DO 111 Parkway, Vienna, MO 65582-8003 Ph: (573) 422-3360 |