Dr. Gregory K. Terpstra D.O., Family Practice, L.L.C.
Organization Active NPI Primary Care Clinic/Center · Potosi, MO
NPI 1295867968 · NPPES record last updated May 13, 2008
Key facts
- NPI
- 1295867968
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Primary Care Clinic/Center 261QP2300X
- License
- 110137 (MO)
- Legal business name
- DR. GREGORY K. TERPSTRA D.O., FAMILY PRACTICE, L.L.C.
- Practice address
- 612 E High St Ste 210
Potosi, MO 63664-1426 - Phone
- (573) 438-3660
- Fax
- (573) 438-1140
- NPI assigned
- Mar 9, 2007
- Organization subpart
- No
Authorized official
- Name
- Mrs. Wilma Terpstra
- Title
- Office Manager
- Phone
- (573) 438-3660
Practitioners 1
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in MO
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20080514000406 | MO | Part B Supplier - Clinic/Group Practice | 8426127648 |
Receives reassigned benefits from 1 practitioner Practice locations: Potosi, MO |
National Provider Directory
Locations
612 E High St
Ste 210
Potosi, MO 63664
Phone (573) 430-3660
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Primary Care Clinic/Center | 261QP2300X | 110137 | MO | Yes |
Addresses
Primary practice location
612 E High St Ste 210
Potosi, MO 63664-1426
Mailing address
612 E High St Ste 210
Potosi, MO 63664-1426
Phone (573) 438-3660
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All providers in Potosi, MO · Primary Care Clinic/Center in Missouri
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on May 13, 2008. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.