| Tcmh Family Clinic - Licking | |
|
233 South Main Street Licking MO 65542 | |
| (573) 674-3011 | |
| (573) 674-4765 |
| Full Name | Tcmh Family Clinic - Licking |
|---|---|
| Speciality | Clinic/Center |
| Location | 233 South Main Street, Licking, Missouri |
| Authorized Official Name and Position | Linda J Pamperien (CFO) |
| Authorized Official Contact | 4179673311 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Tcmh Family Clinic - Licking Po Box 47 Licking MO 65542-0047 Ph: (573) 674-3011 | Tcmh Family Clinic - Licking 233 South Main Street Licking MO 65542 Ph: (573) 674-3011 |
| NPI Number | 1447412770 |
|---|---|
| Provider Enumeration Date | 06/27/2008 |
| Last Update Date | 07/17/2009 |
| Medicare PECOS PAC ID | 9436041696 |
|---|---|
| Medicare Enrollment ID | O20080826000242 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1447412770 | NPI | - | NPPES |
| 26D0679044 | Other | MO | CLIA |
| 1447412770 | Other | MO | RH - MEDICAID |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QR1300X | Clinic/center - Rural Health | (* (Not Available)) | Primary |
Tcmh Family Clinic - Licking Primary Care Clinic Medicare: Medicare Enrolled Practice Location: Main & Myers, Licking, MO 65542 Phone: 573-674-3011 Fax: 573-674-4765 | |
Douglas County Public Health Services Group, Inc. Primary Care Clinic Medicare: Medicare Enrolled Practice Location: 135 College Ave., Licking, MO 65542 Phone: 417-683-4831 |