| 417 Health Care | |
|
830 W Mount Vernon St Ste 10 Nixa MO 65714-9615 | |
| (417) 374-4141 | |
| (417) 374-4140 |
| Full Name | 417 Health Care |
|---|---|
| Speciality | Family Medicine |
| Location | 830 W Mount Vernon St Ste 10, Nixa, Missouri |
| Authorized Official Name and Position | Daina Kays (OWNER) |
| Authorized Official Contact | 4173744141 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| 417 Health Care 830 W Mount Vernon St Ste 10 Nixa MO 65714-9615 Ph: (417) 374-4141 | 417 Health Care 830 W Mount Vernon St Ste 10 Nixa MO 65714-9615 Ph: (417) 374-4141 |
| NPI Number | 1689321218 |
|---|---|
| Provider Enumeration Date | 03/03/2022 |
| Last Update Date | 03/03/2022 |
| Medicare PECOS PAC ID | 8921494535 |
|---|---|
| Medicare Enrollment ID | O20220407002093 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1689321218 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | (* (Not Available)) | Primary |
| Provider Name | Jerry L Fenwick |
|---|---|
| Provider Type | Practitioner - Emergency Medicine |
| Provider Identifiers | NPI Number: 1366477549 PECOS PAC ID: 6608973698 Enrollment ID: I20070529000081 |
| Provider Name | Daina Kays |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1386906451 PECOS PAC ID: 2163672494 Enrollment ID: I20121023000639 |
St. John's Clinic, Inc. Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 940 W Mount Vernon St, Nixa, MO 65714 Phone: 417-724-5437 Fax: 417-724-5433 | |
Alps Health, Llc Primary Care Clinic Medicare: Medicare Enrolled Practice Location: 1824 N State Highway Cc Ste B, Nixa, MO 65714 Phone: 417-719-4510 | |
Regional Services Primary Care Clinic Medicare: Medicare Enrolled Practice Location: 501 N Old Wilderness Rd, Nixa, MO 65714 Phone: 417-269-2227 Fax: 417-269-2235 |