| Great Mines Health Center | |
|
10047 Diamond Rd Rm 809 Cadet MO 63630-9581 | |
| (573) 438-4982 | |
| (573) 438-1212 |
| Full Name | Great Mines Health Center |
|---|---|
| Speciality | Clinic/Center |
| Location | 10047 Diamond Rd Rm 809, Cadet, Missouri |
| Authorized Official Name and Position | Gregory A Roeback (CHIEF EXECUTIVE OFFICER) |
| Authorized Official Contact | 5734389355 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Great Mines Health Center Po Box 761 Potosi MO 63664-0761 Ph: (573) 435-9355 | Great Mines Health Center 10047 Diamond Rd Rm 809 Cadet MO 63630-9581 Ph: (573) 438-4982 |
| NPI Number | 1548750847 |
|---|---|
| Provider Enumeration Date | 05/14/2018 |
| Last Update Date | 05/14/2018 |
| Medicare PECOS PAC ID | 3072598143 |
|---|---|
| Medicare Enrollment ID | O20181030000399 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1548750847 | NPI | - | NPPES |
| H80CS06670-13-02 | Other | HRSA |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QF0400X | Clinic/center - Federally Qualified Health Center (fqhc) | H80CS06670-13-02 (* (Not Available)) | Primary |
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