Organization
LAURIE A BEACH
Active
Other names
Pilot Grove Rural Health Clinic
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. LAURIE A BEACH FNP (OWNER)
(660) 834-5100
Entity
Organization
Contact information
Practice address
212 COLLEGE ST, PILOT GROVE, MO 65276-1005
(660) 834-5100
(660) 834-5101
Mailing address
PO BOX 817, CAPE GIRARDEAU, MO 63702-0817
(573) 335-4715
(573) 334-2303
Taxonomy
Speciality
Code
Description
License number
State
261QR1300X
Rural Health Clinic/Center
—
—
363L00000X
Nurse Practitioner
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000014600
MEDICARE PART B
MO
Enumeration date
04/12/2007
Last updated
02/12/2009
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