| Douglas County Public Health Services Group, Inc. | |
|
135 College Ave. Licking MO 65542 | |
| (417) 683-4831 | |
| Not Available |
| Full Name | Douglas County Public Health Services Group, Inc. |
|---|---|
| Speciality | Family Medicine |
| Location | 135 College Ave., Licking, Missouri |
| Authorized Official Name and Position | Jennifer Heinlein (COO) |
| Authorized Official Contact | 4176834831 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Douglas County Public Health Services Group, Inc. Po Box 1359 Ava MO 65608-1359 Ph: (417) 683-4831 | Douglas County Public Health Services Group, Inc. 135 College Ave. Licking MO 65542 Ph: (417) 683-4831 |
| NPI Number | 1629639109 |
|---|---|
| Provider Enumeration Date | 06/25/2019 |
| Last Update Date | 06/25/2019 |
| Medicare PECOS PAC ID | 3072423052 |
|---|---|
| Medicare Enrollment ID | O20191118001202 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1629639109 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | (* (Not Available)) | Primary |
Tcmh Family Clinic - Licking Primary Care Clinic Medicare: Medicare Enrolled Practice Location: Main & Myers, Licking, MO 65542 Phone: 573-674-3011 Fax: 573-674-4765 | |
Tcmh Family Clinic - Licking Primary Care Clinic Medicare: Medicare Enrolled Practice Location: 233 South Main Street, Licking, MO 65542 Phone: 573-674-3011 Fax: 573-674-4765 |