Provider Demographics
NPI:1902984941
Name:FAMILY PRACTICE ASSOCIATES OF WEST CENTRAL MO PC
Entity Type:Organization
Organization Name:FAMILY PRACTICE ASSOCIATES OF WEST CENTRAL MO PC
Other - Org Name:HIGGINSVILLE RURAL HEALTH CLINIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRACTICE ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:DEBORAH
Authorized Official - Middle Name:M
Authorized Official - Last Name:SKWARLO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:660-584-2820
Mailing Address - Street 1:1200 W 22ND ST
Mailing Address - Street 2:
Mailing Address - City:HIGGINSVILLE
Mailing Address - State:MO
Mailing Address - Zip Code:64037-1420
Mailing Address - Country:US
Mailing Address - Phone:660-584-7751
Mailing Address - Fax:660-584-8261
Practice Address - Street 1:1200 W 22ND ST
Practice Address - Street 2:
Practice Address - City:HIGGINSVILLE
Practice Address - State:MO
Practice Address - Zip Code:64037-1420
Practice Address - Country:US
Practice Address - Phone:660-584-7751
Practice Address - Fax:660-584-8261
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:FAMILY PRACTICE ASSOCIATES OF WEST CENTRAL MO PC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-11-01
Last Update Date:2008-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR1300XAmbulatory Health Care FacilitiesClinic/CenterRural Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS592144505Medicaid
MO263919Medicare Oscar/Certification