MEDICARE: DR. RACHELLE L GORRELL D.O.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207Q00000X	Family Medicine Physician	2001007763	MO

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	002013368	OTHER	MO	FFS MEDICARE/WPS
2	263904	OTHER	MO	RURAL HEALTH MEDICARE
9	080174605	OTHER	MO	RAILROAD MEDICARE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
3	431908560	OTHER	MO	TRIWEST
4	464413	OTHER	MO	HEALTHLINK
5	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
6	431908560	OTHER	MO	PHCS
7	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
8	0101983	OTHER	MO	UNITED HEALTH CARE
10	144176	OTHER	MO	BLUE SHIELD OF MO

General Provider Information

NPI Number	:	1336114800
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. RACHELLE L GORRELL D.O.

Provider Business Mailing Address
First Line	:	1050 W 10TH ST
Second Line	:
City	:	ROLLA
State	:	MO
Zip	:	65401-2905
Country	:	US
Telephone Number	:	573-364-9000
Fax Number	:

Provider Business Practice Location Address
First Line	:	1000 N JEFFERSON ST
Second Line	:
City	:	SAINT JAMES
State	:	MO
Zip	:	65559
Country	:	US
Telephone Number	:	573-265-8840
Fax Number	:	573-202-2474

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/20/2006
Last Update Date	:	08/22/2019

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Directions to “ DR. RACHELLE L GORRELL D.O.” Practice Location

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