A Pattern Health Clinic, Inc
Organization Active NPI Clinic/Center · Marshall, MO
NPI 1710320643 · NPPES record last updated Jun 1, 2015
Key facts
- NPI
- 1710320643
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Clinic/Center 261Q00000X
- License
- 01272547 (MO)
- Legal business name
- A PATTERN HEALTH CLINIC, INC
- Practice address
- 1674 S Odell Ave
Marshall, MO 65340-3365 - Phone
- (660) 886-9852
- Fax
- (816) 787-1368
- NPI assigned
- Apr 10, 2013
- Organization subpart
- No
Authorized official
- Name
- Annex Luberisse
- Title
- President
- Phone
- (660) 886-9852
Practitioners 2
-
Annex Luberisse, ND
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in MO
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20130802000790 | MO | Part B Supplier - Clinic/Group Practice | 1557502549 |
Receives reassigned benefits from 1 practitioner Practice locations: Bourbon, MO; Jefferson City, MO |
National Provider Directory
Locations
418 E Walnut St
Boonville, MO 65233
Phone (660) 886-9852
1406 Missouri Blvd
Ste A
Jefferson City, MO 65109
Phone (660) 229-0858
1674 S Odell Ave
Ste B
Marshall, MO 65340
Phone (660) 886-9852
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Clinic/Center | 261Q00000X | 01272547 | MO | Yes |
Addresses
Primary practice location
1674 S Odell Ave
Marshall, MO 65340-3365
Mailing address
1674 South Odell Ave
Marshall, MO 65340
Phone (660) 886-9852
Other names
- A Pattern Health Clinic
Other providers in Marshall, MO
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jun 1, 2015. 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.