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100 W 4th Street Montrose MO 64770-9336 | |
(660) 693-8885 | |
(660) 693-8844 |
Full Name | |
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Speciality | Family Medicine |
Location | 100 W 4th Street, Montrose, Missouri |
Authorized Official Name and Position | Kadeena Nitchals (ADMINISTRATOR) |
Authorized Official Contact | 6604762121 |
Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
Mailing Address | Practice Location Address |
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100 W 4th Street Montrose MO 64770-9336 Ph: (660) 693-8885 | 100 W 4th Street Montrose MO 64770-9336 Ph: (660) 693-8885 |
NPI Number | 1518024553 |
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Provider Enumeration Date | 01/02/2007 |
Last Update Date | 09/12/2011 |
Identifier | Type | State | Issuer |
---|---|---|---|
1518024553 | NPI | - | NPPES |
598999001 | Medicaid | MO |
Taxonomy | Type | License (State) | Status |
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207Q00000X | Family Medicine | (* (Not Available)) | Primary |