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Organization

BLESSING CORPORATE SERVICES INC

Active
Other names
Palmyra Clinic
Organization subpart
No

Provider details

NPI number
Authorized official
TIM MOORE (VP FINANCE / CAO)
(217) 223-8400
Entity
Organization

Contact information

Practice address
6996 COUNTY ROAD 326, PALMYRA, MO 63461-3119
(573) 769-3710
(573) 769-3753
Mailing address
6996 COUNTY ROAD 326, PALMYRA, MO 63461-3119
(573) 769-3710
(573) 769-3753

Taxonomy

Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
261QR1300X
Rural Health Clinic/Center
Primary
363LF0000X
Family Nurse Practitioner

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
151774
BLUE SHIELD OF MO
MO
01
505757104
MEDICAID PROVIDER NUMBER
MO
01
598783801
MEDICAID PROVIDER NUMBER
MO
01
DA9532
RAIL ROAD MEDICARE
IL
Enumeration date
09/20/2006
Last updated
11/27/2023
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