| |
6996 County Road 326 Palmyra MO 63461-3119 | |
(573) 769-3710 | |
(573) 769-3753 |
Full Name | |
---|---|
Speciality | Clinic/center - Rural Health |
Location | 6996 County Road 326, Palmyra, Missouri |
Authorized Official Name and Position | Tim Moore (VP FINANCE / CAO) |
Authorized Official Contact | 2172238400 |
Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
Mailing Address | Practice Location Address |
---|---|
6996 County Road 326 Palmyra MO 63461-3119 Ph: (573) 769-3710 | 6996 County Road 326 Palmyra MO 63461-3119 Ph: (573) 769-3710 |
NPI Number | 1548368004 |
---|---|
Provider Enumeration Date | 09/20/2006 |
Last Update Date | 11/27/2023 |
Identifier | Type | State | Issuer |
---|---|---|---|
1548368004 | NPI | - | NPPES |
151774 | Other | MO | BLUE SHIELD OF MO |
505757104 | Other | MO | MEDICAID PROVIDER NUMBER |
598783801 | Other | MO | MEDICAID PROVIDER NUMBER |
DA9532 | Other | IL | RAIL ROAD MEDICARE |