Organization
BIG SPRINGS MEDICAL ASSOCIATION
Active
Parent organization
BIG SPRINGS MEDICAL ASSOCIATION
Other names
Wayne County Medical Clinic
Organization subpart
Yes
Provider details
NPI number
Legal business name
BIG SPRINGS MEDICAL ASSOCIATION
Authorized official
SHERILYN CLARK (CEO)
(573) 663-2313
Entity
Organization
Contact information
Practice address
135 MAIN STREET, GREENVILLE, MO 63944
(573) 224-3660
(573) 224-3770
Mailing address
PO BOX 157, ELLINGTON, MO 63638-0157
(573) 663-2313
(573) 663-2441
Taxonomy
Speciality
Code
Description
License number
State
261QF0400X
Federally Qualified Health Center (FQHC)
Primary
—
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000010497
STATE MEDICARE
MO
05
—
1801021142
—
MO
Enumeration date
05/15/2009
Last updated
07/18/2013
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