| Edgar M Conrad Iv, Llc | |
|
2700 Cunningham Ave Suite 103 Joplin MO 64801-1570 | |
| (417) 782-3292 | |
| (417) 782-4024 |
| Full Name | Edgar M Conrad Iv, Llc |
|---|---|
| Speciality | Internal Medicine |
| Location | 2700 Cunningham Ave, Joplin, Missouri |
| Authorized Official Name and Position | Edgar M Conrad (PROPRIETOR) |
| Authorized Official Contact | 4147823292 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Edgar M Conrad Iv, Llc 2700 Cunningham Ave Suite 103 Joplin MO 64801-1570 Ph: (417) 782-3292 | Edgar M Conrad Iv, Llc 2700 Cunningham Ave Suite 103 Joplin MO 64801-1570 Ph: (417) 782-3292 |
| NPI Number | 1336309228 |
|---|---|
| Provider Enumeration Date | 06/13/2008 |
| Last Update Date | 08/11/2008 |
| Medicare PECOS PAC ID | 2668546409 |
|---|---|
| Medicare Enrollment ID | O20090112000362 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1336309228 | NPI | - | NPPES |
| 248016636 | Medicaid | MO |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207R00000X | Internal Medicine | 107748 (Missouri) | Primary |
| Provider Name | Edgar M Conrad |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1124055074 PECOS PAC ID: 0042250920 Enrollment ID: I20050510000819 |
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