| Doctors Inn Clinic Llc | |
|
1112 South Byp Ste C Suite C Kennett MO 63857-3738 | |
| (573) 717-1776 | |
| (573) 717-1572 |
| Full Name | Doctors Inn Clinic Llc |
|---|---|
| Speciality | Family Medicine |
| Location | 1112 South Byp Ste C, Kennett, Missouri |
| Authorized Official Name and Position | Debbie A Wade (NP) |
| Authorized Official Contact | 5737171776 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Doctors Inn Clinic Llc 1112 South Byp Suite C Kennett MO 63857-3738 Ph: (573) 717-1776 | Doctors Inn Clinic Llc 1112 South Byp Ste C Suite C Kennett MO 63857-3738 Ph: (573) 717-1776 |
| NPI Number | 1114117306 |
|---|---|
| Provider Enumeration Date | 07/25/2007 |
| Last Update Date | 02/26/2010 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1114117306 | NPI | - | NPPES |
| 595409004 | Medicaid | MO | |
| 109494A-001 | Other | MO | BLUE CROSS MISSOURI |
| SM707 | Other | MO | BLUE CROSS ARKANSAS |
| 150606001 | Other | MO | ARKANSAS MEDICAID |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | 2000148413 (Missouri) | Primary |
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