| Central Missouri Palliative Care | |
|
1001 Southwest Blvd Ste 1 Jefferson City MO 65109-2534 | |
| (573) 415-0269 | |
| (573) 415-0389 |
| Full Name | Central Missouri Palliative Care |
|---|---|
| Speciality | Family Medicine |
| Location | 1001 Southwest Blvd Ste 1, Jefferson City, Missouri |
| Authorized Official Name and Position | Joshua L Proffitt (PRESIDENT) |
| Authorized Official Contact | 3372331307 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Central Missouri Palliative Care Po Box 51266 Lafayette LA 70505-1266 Ph: (337) 233-1307 | Central Missouri Palliative Care 1001 Southwest Blvd Ste 1 Jefferson City MO 65109-2534 Ph: (573) 415-0269 |
| NPI Number | 1215516935 |
|---|---|
| Provider Enumeration Date | 04/08/2021 |
| Last Update Date | 12/18/2023 |
| Medicare PECOS PAC ID | 6709294317 |
|---|---|
| Medicare Enrollment ID | O20210421000151 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1215516935 | NPI | - | NPPES |
| Provider Name | Mark A Rosales |
|---|---|
| Provider Type | Practitioner - Hospice/palliative Care |
| Provider Identifiers | NPI Number: 1962446070 PECOS PAC ID: 5294741278 Enrollment ID: I20060228000597 |
| Provider Name | Anna B Hummel |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1447580030 PECOS PAC ID: 7719012640 Enrollment ID: I20100317000955 |
| Provider Name | Melissa Renee Koga |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1922356294 PECOS PAC ID: 1759532385 Enrollment ID: I20121108000100 |
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