Facts
- Status
- A
- Type
- Organization
- Enumeration date
- 2007-03-22
- Last updated
- 2014-05-12
Specialties
Licenses
The registry row did not include a license.
Location
- Practice location
- 256 STATE HIGHWAY Y
- City
- FORSYTH MO
- Postal code
- 656535618
- Phone
- 417-546-4200
Organization contact
- Name
- JANIECE BRIDGES
- Title
- Medical Director
- Phone
- 4175464200
Medicare
- PECOS
- A PECOS enrollment row matches this NPI.
LEIE
The OIG NPI list is not in this build yet. Confirm on OIG's search.
Nearby
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Removal request
Public data from NPPES and CMS. Not a credentialing determination.