| Bootheel Primary Care-caruthersville | |
|
1502 Ward Ave Caruthersville MO 63830-2571 | |
| (573) 333-4244 | |
| Not Available |
| Full Name | Bootheel Primary Care-caruthersville |
|---|---|
| Speciality | Clinic/Center |
| Location | 1502 Ward Ave, Caruthersville, Missouri |
| Authorized Official Name and Position | Joan White-wagoner (CEO) |
| Authorized Official Contact | 5733593612 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Bootheel Primary Care-caruthersville 946 E Reed St P O Box 442 Hayti MO 63851-1243 Ph: (573) 359-1372 | Bootheel Primary Care-caruthersville 1502 Ward Ave Caruthersville MO 63830-2571 Ph: (573) 333-4244 |
| NPI Number | 1841463551 |
|---|---|
| Provider Enumeration Date | 04/03/2008 |
| Last Update Date | 09/27/2023 |
| Medicare PECOS PAC ID | 8426024159 |
|---|---|
| Medicare Enrollment ID | O20081022000544 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1841463551 | NPI | - | NPPES |
| 1841463551 | Medicaid | MO |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QR1300X | Clinic/center - Rural Health | (* (Not Available)) | Primary |
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