| A Pattern Health Clinic, Inc | |
|
1674 S Odell Ave Marshall MO 65340-3365 | |
| (660) 886-9852 | |
| (816) 787-1368 |
| Full Name | A Pattern Health Clinic, Inc |
|---|---|
| Speciality | Clinic/Center |
| Location | 1674 S Odell Ave, Marshall, Missouri |
| Authorized Official Name and Position | Annex Luberisse (PRESIDENT) |
| Authorized Official Contact | 6608869852 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| A Pattern Health Clinic, Inc 1674 South Odell Ave Marshall MO 65340 Ph: (660) 886-9852 | A Pattern Health Clinic, Inc 1674 S Odell Ave Marshall MO 65340-3365 Ph: (660) 886-9852 |
| NPI Number | 1710320643 |
|---|---|
| Provider Enumeration Date | 04/10/2013 |
| Last Update Date | 06/01/2015 |
| Medicare PECOS PAC ID | 1557502549 |
|---|---|
| Medicare Enrollment ID | O20130802000790 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1710320643 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261Q00000X | Clinic/center | 01272547 (Missouri) | Primary |
| Provider Name | Andrew Scott Grivas |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1285658815 PECOS PAC ID: 6901829506 Enrollment ID: I20130802000821 |
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