| Comtrea | |
|
1817 Gravois Rd High Ridge MO 63049-2668 | |
| (636) 376-0079 | |
| (636) 677-8400 |
| Full Name | Comtrea |
|---|---|
| Speciality | Clinic/Center |
| Location | 1817 Gravois Rd, High Ridge, Missouri |
| Authorized Official Name and Position | Teresa L Porter (CREDENTIALING MANAGER) |
| Authorized Official Contact | 6364666452 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Comtrea 1800 Community Clinton MO 64735-8804 Ph: (844) 853-8937 | Comtrea 1817 Gravois Rd High Ridge MO 63049-2668 Ph: (636) 376-0079 |
| NPI Number | 1356751648 |
|---|---|
| Provider Enumeration Date | 05/07/2014 |
| Last Update Date | 08/23/2023 |
| Medicare PECOS PAC ID | 1951206754 |
|---|---|
| Medicare Enrollment ID | O20230926000332 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1356751648 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QF0400X | Clinic/center - Federally Qualified Health Center (fqhc) | (* (Not Available)) | Primary |
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