| Guardian Primary Care LLC | |
|
2441 Myra Dr Cape Girardeau MO 63703-5803 | |
| (573) 200-6390 | |
| (573) 755-0706 |
| Full Name | Guardian Primary Care LLC |
|---|---|
| Speciality | Family Medicine |
| Location | 2441 Myra Dr, Cape Girardeau, Missouri |
| Authorized Official Name and Position | Preston Thomas Holifield (OWNER) |
| Authorized Official Contact | 5732006390 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Guardian Primary Care LLC 2441 Myra Dr Cape Girardeau MO 63703-5803 Ph: (573) 200-6390 | Guardian Primary Care LLC 2441 Myra Dr Cape Girardeau MO 63703-5803 Ph: (573) 200-6390 |
| NPI Number | 1568286110 |
|---|---|
| Provider Enumeration Date | 11/11/2024 |
| Last Update Date | 04/11/2026 |
| Certification Date | 04/11/2026 |
| Medicare PECOS PAC ID | 1254869928 |
|---|---|
| Medicare Enrollment ID | O20250108002174 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1568286110 | NPI | - | NPPES |
| 500150249 | Medicaid | MO |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | () | Primary |
| Provider Name | Preston Thomas Holifield |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1982397436 PECOS PAC ID: 7517326192 Enrollment ID: I20230629001269 |
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