| Canton/lagrange Family Practice | |
|
1802 Elm St Canton MO 63435-1694 | |
| (573) 655-4891 | |
| (573) 288-5361 |
| Full Name | Canton/lagrange Family Practice |
|---|---|
| Speciality | Clinic/Center |
| Location | 1802 Elm St, Canton, Missouri |
| Authorized Official Name and Position | Rob Gasaway (VP OF FINANCE) |
| Authorized Official Contact | 5734061608 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Canton/lagrange Family Practice 6500 Hospital Dr Hannibal MO 63401-6890 Ph: (573) 221-3415 | Canton/lagrange Family Practice 1802 Elm St Canton MO 63435-1694 Ph: (573) 655-4891 |
| NPI Number | 1063431575 |
|---|---|
| Provider Enumeration Date | 07/18/2006 |
| Last Update Date | 05/25/2021 |
| Certification Date | 05/25/2021 |
| Medicare PECOS PAC ID | 1254236300 |
|---|---|
| Medicare Enrollment ID | O20080118000508 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1063431575 | NPI | - | NPPES |
| 590416004 | Medicaid | MO |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QR1300X | Clinic/center - Rural Health | () | Primary |
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