Provider Demographics
NPI:1013948868
Name:BATES COUNTY MEDICAL CLINIC INC
Entity Type:Organization
Organization Name:BATES COUNTY MEDICAL CLINIC INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:W
Authorized Official - Last Name:HAYNIE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:660-679-3118
Mailing Address - Street 1:PO BOX 390
Mailing Address - Street 2:
Mailing Address - City:BUTLER
Mailing Address - State:MO
Mailing Address - Zip Code:64730-0390
Mailing Address - Country:US
Mailing Address - Phone:660-679-3118
Mailing Address - Fax:660-679-6328
Practice Address - Street 1:706 S HIGH ST
Practice Address - Street 2:
Practice Address - City:BUTLER
Practice Address - State:MO
Practice Address - Zip Code:64730-1833
Practice Address - Country:US
Practice Address - Phone:660-679-3118
Practice Address - Fax:660-679-6328
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-06
Last Update Date:2009-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QR1300XAmbulatory Health Care FacilitiesClinic/CenterRural Health
No207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO500472907Medicaid
MO268989Medicare Oscar/Certification
MO3130000Medicare ID - Type UnspecifiedMEDICARE GROUP PROVIDER