Full Name | |
---|---|
Speciality | Clinic/center - Primary Care |
Location | 401 East Hwy 19, Center, Missouri |
Authorized Official Name and Position | Rob Gasaway (VP OF FINANCE) |
Authorized Official Contact | 5734061608 |
Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
Mailing Address | Practice Location Address |
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Po Box 1239 Hannibal MO 63401-1239 Ph: (573) 221-3415 | 401 East Hwy 19 Center MO 63436 Ph: (573) 267-3318 |
NPI Number | 1073532560 |
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Provider Enumeration Date | 07/18/2006 |
Last Update Date | 05/25/2021 |
Identifier | Type | State | Issuer |
---|---|---|---|
1073532560 | NPI | - | NPPES |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
261QP2300X | Clinic/center - Primary Care | (* (Not Available)) | Primary |