| Samuel O Fadare, Md, Pc | |
|
5604 Ne Antioch Rd Gladstone MO 64119-2327 | |
| (660) 372-1313 | |
| (660) 372-1339 |
| Full Name | Samuel O Fadare, Md, Pc |
|---|---|
| Speciality | Clinic/Center |
| Location | 5604 Ne Antioch Rd, Gladstone, Missouri |
| Authorized Official Name and Position | Samuel O Fadare (OWNER) |
| Authorized Official Contact | 8162256735 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Samuel O Fadare, Md, Pc 1513 Union Ave Ste 2500 Moberly MO 65270-9412 Ph: (660) 372-1313 | Samuel O Fadare, Md, Pc 5604 Ne Antioch Rd Gladstone MO 64119-2327 Ph: (660) 372-1313 |
| NPI Number | 1639287824 |
|---|---|
| Provider Enumeration Date | 08/28/2006 |
| Last Update Date | 12/08/2020 |
| Certification Date | 12/08/2020 |
| Medicare PECOS PAC ID | 3072615525 |
|---|---|
| Medicare Enrollment ID | O20070301000301 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1639287824 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QM0850X | Clinic/center - Adult Mental Health | (* (Not Available)) | Primary |
| Provider Name | Samuel O Fadare |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1184685802 PECOS PAC ID: 7012914997 Enrollment ID: I20090211000649 |
| Provider Name | Joy N Eke |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1285752865 PECOS PAC ID: 9931123882 Enrollment ID: I20220803001822 |
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