Basic Information
| Provider Information | |||||||||
| NPI: | 1336114800 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | GORRELL | ||||||||
| FirstName: | RACHELLE | ||||||||
| MiddleName: | L | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | D.O. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1050 W 10TH ST | ||||||||
| Address2: | |||||||||
| City: | ROLLA | ||||||||
| State: | MO | ||||||||
| PostalCode: | 654012905 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5733649000 | ||||||||
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| Practice Location | |||||||||
| Address1: | 1000 N JEFFERSON ST | ||||||||
| Address2: | |||||||||
| City: | SAINT JAMES | ||||||||
| State: | MO | ||||||||
| PostalCode: | 65559 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5732658840 | ||||||||
| FaxNumber: | 5732022474 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/20/2006 | ||||||||
| LastUpdateDate: | 08/22/2019 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | 2001007763 | MO | Y | Allopathic & Osteopathic Physicians | Family Medicine |
ID Information
| ID | Type | State | Issuer | Description | 002013368 | 01 | MO | FFS MEDICARE/WPS | OTHER | 263904 | 01 | MO | RURAL HEALTH MEDICARE | OTHER | 431908560 | 01 | MO | TRIWEST | OTHER | 464413 | 01 | MO | HEALTHLINK | OTHER | 245323704 | 05 | MO | MEDICAID | 431908560 | 01 | MO | PHCS | OTHER | 596841403 | 05 | MO | MEDICAID | 0101983 | 01 | MO | UNITED HEALTH CARE | OTHER | 080174605 | 01 | MO | RAILROAD MEDICARE | OTHER | 144176 | 01 | MO | BLUE SHIELD OF MO | OTHER |