| Calvary Medical Center, Llc | |
|
450 New Creation Road North Newark MO 63458-9744 | |
| (660) 284-4300 | |
| (660) 284-4339 |
| Full Name | Calvary Medical Center, Llc |
|---|---|
| Speciality | Family Medicine |
| Location | 450 New Creation Road North, Newark, Missouri |
| Authorized Official Name and Position | Wendell A Nickerson (OWNER) |
| Authorized Official Contact | 6602844300 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Calvary Medical Center, Llc 450 New Creation Road North Newark MO 63458-9744 Ph: () - | Calvary Medical Center, Llc 450 New Creation Road North Newark MO 63458-9744 Ph: (660) 284-4300 |
| NPI Number | 1528263464 |
|---|---|
| Provider Enumeration Date | 06/20/2007 |
| Last Update Date | 11/09/2010 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1528263464 | NPI | - | NPPES |
| 509038808 | Medicaid | MO |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | R9345 (Missouri) | Primary |