| Ccmh Medical Mall Clinic | |
|
1317 S State Highway 32 El Dorado Springs MO 64744-2302 | |
| (417) 876-3333 | |
| (417) 876-4509 |
| Full Name | Ccmh Medical Mall Clinic |
|---|---|
| Speciality | Clinic/Center |
| Location | 1317 S State Highway 32, El Dorado Springs, Missouri |
| Authorized Official Name and Position | Terry W Nichols (CEO) |
| Authorized Official Contact | 4178762511 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Ccmh Medical Mall Clinic 1401 S Park St El Dorado Springs MO 64744-2037 Ph: (417) 876-2511 | Ccmh Medical Mall Clinic 1317 S State Highway 32 El Dorado Springs MO 64744-2302 Ph: (417) 876-3333 |
| NPI Number | 1992827273 |
|---|---|
| Provider Enumeration Date | 04/06/2007 |
| Last Update Date | 03/06/2023 |
| Medicare PECOS PAC ID | 7315841129 |
|---|---|
| Medicare Enrollment ID | O20041027000976 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1992827273 | NPI | - | NPPES |
| 508079605 | Medicaid | MO |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261Q00000X | Clinic/center | (* (Not Available)) | Primary |
| Provider Name | James Riscoe |
|---|---|
| Provider Type | Practitioner - Emergency Medicine |
| Provider Identifiers | NPI Number: 1386681997 PECOS PAC ID: 4284600891 Enrollment ID: I20040904000067 |
| Provider Name | Russell R Kemm |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1649277831 PECOS PAC ID: 2062555139 Enrollment ID: I20100211000653 |
| Provider Name | Tedi E Payne |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1083055800 PECOS PAC ID: 8820222755 Enrollment ID: I20131009000731 |
| Provider Name | Molly Moore Mcgraw Davidson |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1104327576 PECOS PAC ID: 9335498450 Enrollment ID: I20180823000980 |
| Provider Name | Patricia Myers |
|---|---|
| Provider Type | Practitioner - Hospitalist |
| Provider Identifiers | NPI Number: 1336381474 PECOS PAC ID: 5092603753 Enrollment ID: I20211013001628 |
| Provider Name | Brooke N Mcpeak |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1326800335 PECOS PAC ID: 5294179404 Enrollment ID: I20240215002487 |
I Am Health Clinic, Llc Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 1005 S Allison Rd, Suite A, El Dorado Springs, MO 64744 Phone: 417-876-4771 Fax: 417-876-4775 | |
Pathways Community Behavioral Healthcare Primary Care Clinic Medicare: Medicare Enrolled Practice Location: 107 W Broadway St, El Dorado Springs, MO 64744 Phone: 660-890-8186 | |
Mercy Clinic Family Medicine-el Dorado Springs Primary Care Clinic Medicare: Medicare Enrolled Practice Location: 309 E Hospital Rd, El Dorado Springs, MO 64744 Phone: 417-876-5851 Fax: 417-876-5484 | |
Cmh El Dorado Springs Medical Center Primary Care Clinic Medicare: Medicare Enrolled Practice Location: 322 E Hospital Road, El Dorado Springs, MO 64744 Phone: 417-876-2118 Fax: 417-876-2175 | |
Ccmh Medical Mall Clinic Primary Care Clinic Medicare: Medicare Enrolled Practice Location: 1317 S State Highway 32, El Dorado Springs, MO 64744 Phone: 417-876-3333 Fax: 417-876-4509 |