| Primary Care Of Bonne Terre Llc | |
|
527 Benham St Bonne Terre MO 63628-1205 | |
| (573) 358-9119 | |
| (573) 358-9489 |
| Full Name | Primary Care Of Bonne Terre Llc |
|---|---|
| Speciality | General Practice |
| Location | 527 Benham St, Bonne Terre, Missouri |
| Authorized Official Name and Position | Andrew J Ninichuck (OWNER) |
| Authorized Official Contact | 5733589119 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Primary Care Of Bonne Terre Llc 527 Benham St Bonne Terre MO 63628-1205 Ph: (573) 358-9119 | Primary Care Of Bonne Terre Llc 527 Benham St Bonne Terre MO 63628-1205 Ph: (573) 358-9119 |
| NPI Number | 1962883751 |
|---|---|
| Provider Enumeration Date | 06/17/2015 |
| Last Update Date | 11/23/2015 |
| Medicare PECOS PAC ID | 4183925415 |
|---|---|
| Medicare Enrollment ID | O20151210001830 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1962883751 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QP2300X | Clinic/center - Primary Care | (* (Not Available)) | Secondary |
| 208D00000X | General Practice | (* (Not Available)) | Primary |
| Provider Name | Constance Young |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1891767125 PECOS PAC ID: 9537168539 Enrollment ID: I20061219000585 |
| Provider Name | Andrew Ninichuck |
|---|---|
| Provider Type | Practitioner - General Practice |
| Provider Identifiers | NPI Number: 1609841956 PECOS PAC ID: 0749354249 Enrollment ID: I20080731000726 |
Bonne Terre Health Clinic Llc Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 55 Nesbit Dr, Bonne Terre, MO 63628 Phone: 573-358-3343 Fax: 573-358-5458 | |
Bonne Terre Medical Associates, P.c. Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 30 N Allen St, Bonne Terre, MO 63628 Phone: 573-358-3343 | |
Farmington Clinic Company Llc Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 55 Nesbit Dr, Bonne Terre, MO 63628 Phone: 573-358-1480 Fax: 573-358-1489 |