| Keith J Frederick, DO | |
|
1000 W 10th St, Rolla, MO 65401-2905 | |
| (573) 364-9000 | |
| (573) 202-2484 |
| Full Name | Keith J Frederick |
|---|---|
| Gender | Male |
| Speciality | Orthopaedic Surgery |
| Location | 1000 W 10th St, Rolla, Missouri |
| Accepts Medicare Assignments | Medicare enrolled and may accept medicare through third-party reassignment. May prescribe medicare part D drugs. |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1366552762 | NPI | - | NPPES |
| 242256303 | Medicaid | MO |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207X00000X | Orthopaedic Surgery | R4D88 (Missouri) | Primary |
| Entity Name | Pcrmc Medical Group Inc |
|---|---|
| Entity Type | Part B Supplier - Clinic/group Practice |
| Entity Identifiers | NPI Number: 1124237227 PECOS PAC ID: 1557454063 Enrollment ID: O20070829000437 |
| Mailing Address | Practice Location Address |
|---|---|
| Keith J Frederick, DO 1050 W 10th St, Rolla, MO 65401-2905 Ph: (573) 364-9000 | Keith J Frederick, DO 1000 W 10th St, Rolla, MO 65401-2905 Ph: (573) 364-9000 |
Alan D Heincker, D.O. Orthopedic Surgery Medicare: Accepting Medicare Assignments Practice Location: 1050 W 10th St, Rolla, MO 65401 Phone: 573-364-9000 Fax: 573-426-2108 |
Theodore Nmi Koreckij, MD Orthopedic Surgery Medicare: Not Enrolled in Medicare Practice Location: 1050 W 10th St, Rolla, MO 65401 Phone: 573-364-5633 Fax: 573-426-5314 |
Mr. Michael Sterling Potter, MD Orthopedic Surgery Medicare: Accepting Medicare Assignments Practice Location: 1050 W 10th St, Rolla, MO 65401 Phone: 573-364-9000 Fax: 573-202-2484 |
Dr. Andrea Rose Phinney, MD Orthopedic Surgery Medicare: Accepting Medicare Assignments Practice Location: 1050 W 10th St, Rolla, MO 65401 Phone: 573-364-9000 Fax: 573-202-2484 |
Mr. Eugene Hansbrough, MD Orthopedic Surgery Medicare: Not Enrolled in Medicare Practice Location: 411 E Highway 72, Rolla, MO 65401 Phone: 573-718-8234 |
Dr. Sylvester T Youlo, M.D. Orthopedic Surgery Medicare: Accepting Medicare Assignments Practice Location: 1050 W 10th St, Rolla, MO 65401 Phone: 573-364-9000 Fax: 573-426-2108 |