| Omc Adult Cprc | |
|
1211 Porter Wagoner Blvd # 23 West Plains MO 65775-1826 | |
| (417) 257-6762 | |
| (417) 257-5875 |
| Full Name | Omc Adult Cprc |
|---|---|
| Speciality | Community/behavioral Health |
| Location | 1211 Porter Wagoner Blvd # 23, West Plains, Missouri |
| Authorized Official Name and Position | Thomas Keller (PRESIDENT) |
| Authorized Official Contact | 4172579111 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Omc Adult Cprc Po Box 1100 West Plains MO 65775-1100 Ph: () - | Omc Adult Cprc 1211 Porter Wagoner Blvd # 23 West Plains MO 65775-1826 Ph: (417) 257-6762 |
| NPI Number | 1689880973 |
|---|---|
| Provider Enumeration Date | 05/15/2007 |
| Last Update Date | 09/16/2019 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1689880973 | NPI | - | NPPES |
| 87175605 | Medicaid | MO |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 251S00000X | Community/behavioral Health | 147-48 (Missouri) | Primary |
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