Healthcare Provider Details

I. General information

NPI: 1841465671
Provider Name (Legal Business Name): A PLUS FAMILY CLINIC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/23/2008
Last Update Date: 04/23/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

203 E 3RD ST
PORTAGEVILLE MO
63873-1401
US

IV. Provider business mailing address

203 E 3RD ST
PORTAGEVILLE MO
63873-1401
US

V. Phone/Fax

Practice location:
  • Phone: 573-379-2100
  • Fax: 573-379-2101
Mailing address:
  • Phone: 573-379-2100
  • Fax: 573-379-2101

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: MRS. AMY D LEDBETTER
Title or Position: DIRECTOR OF OPERATIONS
Credential:
Phone: 573-651-4488