MEDICARE: TERRY THRASHER D.O. CLINIC

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	261QP2300X	Primary Care Clinic/Center	106165	MO

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	26-8949	OTHER	MO	RURAL HEALTH CLINIC #

General Provider Information

NPI Number	:	1750325585
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	TERRY THRASHER D.O. CLINIC

Provider Business Mailing Address
First Line	:	630 N MORLEY ST
Second Line	:
City	:	MOBERLY
State	:	MO
Zip	:	65270-2556
Country	:	US
Telephone Number	:	660-263-5787
Fax Number	:	660-263-5860

Provider Business Practice Location Address
First Line	:	630 N MORLEY ST
Second Line	:
City	:	MOBERLY
State	:	MO
Zip	:	65270-2556
Country	:	US
Telephone Number	:	660-263-5787
Fax Number	:	660-263-5860

Authorized Official
Title or Position	:	OFFICE MANAGER
Name	:	JANET L GRAVITT
Credential	:
Telephone Number	:	660-263-5787

Provider Enumeration Date	:	06/15/2006
Last Update Date	:	08/22/2020

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