MEDICARE: FOREVER YOUNG

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	261Q00000X	Clinic/Center	R9J48	MO

General Provider Information

NPI Number	:	1619333481
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	FOREVER YOUNG

Provider Business Mailing Address
First Line	:	6031 N MAIN STREET RD
Second Line	:	#395
City	:	WEBB CITY
State	:	MO
Zip	:	64870-7219
Country	:	US
Telephone Number	:	417-206-0900
Fax Number	:	417-206-0907

Provider Business Practice Location Address
First Line	:	6055 N MAIN STREET RD
Second Line	:
City	:	WEBB CITY
State	:	MO
Zip	:	64870-7219
Country	:	US
Telephone Number	:	417-206-0900
Fax Number	:	417-206-0907

Authorized Official
Title or Position	:	MEDICAL DIRECTOR
Name	:	DR. DAVID LARUE
Credential	:	DO
Telephone Number	:	417-206-0900

Provider Enumeration Date	:	01/11/2016
Last Update Date	:	01/11/2016

Similar Medicare Providers

1700066511 — DR. CHAD ISAACS PHARMD
Practice Location Address:

6059 N MAIN STREET RD.
WEBB CITY, MO
64870-7219

Practice Phone: 417-624-6590
Practice Fax: 417-624-6593

1205158375 — STONES CORNER PHARMACY INC
Practice Location Address:

6059 N MAIN STREET RD
WEBB CITY, MO
64870-7219

Practice Phone: 417-624-6590
Practice Fax: 417-624-6593

1164703153 — MR. CHARLES CHRISTOPHER GOSSMAN APRN
Practice Location Address:

6055 N MAIN STREET RD
WEBB CITY, MO
64870-7219

Practice Phone: 417-206-0900
Practice Fax: 417-206-0907

1922427806 — PROFESSIONAL URGENT CARE LLC
Practice Location Address:

6055 N MAIN STREET RD
WEBB CITY, MO
64870-7219

Practice Phone: 620-762-3809
Practice Fax: 620-674-3808

1578415964 — FAITH REH'NEE GUNN-JONES
Practice Location Address:

3308 WILLOW CREEK DR
MIDWEST CITY, OK
73110-7219

Practice Phone: 405-922-0264
Practice Fax:

1588773261 — GARROLD DALE SIBEL DDS
Practice Location Address:

7219 E RENO AVE , DALE SIBEL DDS
MIDWEST CITY, OK
73110-4446

Practice Phone: 405-737-5614
Practice Fax: 405-737-5614

Directions to “FOREVER YOUNG ” Practice Location

Language	Start Address	Practice Location

These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

Copyright © 2007-2026 (Powered by Swiss Vault Engine), all rights reserved. HIPAA liability, trademark, document use and software licensing rules apply. All registered trademarks, used in the content, are the property of their owners. Your interactions with this site are in accordance with our Terms of Use and Privacy Policy.