| Innovative Medical Clinic | |
|
3218 W Edgewood Dr Ste 500 Jefferson City MO 65109 | |
| (949) 696-6157 | |
| Not Available |
| Full Name | Innovative Medical Clinic |
|---|---|
| Speciality | Clinic/Center |
| Location | 3218 W Edgewood Dr, Jefferson City, Missouri |
| Authorized Official Name and Position | Elochukwu Osoego (OWNER) |
| Authorized Official Contact | 9496966157 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Innovative Medical Clinic 3218 W Edgewood Dr Ste 500 Jefferson City MO 65109 Ph: (949) 696-6157 | Innovative Medical Clinic 3218 W Edgewood Dr Ste 500 Jefferson City MO 65109 Ph: (949) 696-6157 |
| NPI Number | 1063290260 |
|---|---|
| Provider Enumeration Date | 09/19/2023 |
| Last Update Date | 09/21/2023 |
| Medicare PECOS PAC ID | 3072961853 |
|---|---|
| Medicare Enrollment ID | O20231205001587 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1063290260 | NPI | - | NPPES |
| Provider Name | Dara J Osoego |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1518327790 PECOS PAC ID: 5991098394 Enrollment ID: I20160722000669 |
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