Organization Name: | M D M DO LLC |
NPI Number: | 1245554815 |
Entity Type Code: | Organizational (2) |
Authorized Official Name: | MARK D MATTHEWS (OWNER/PHYSICIAN) |
Mailing Address: | 825 E Highway 60 Suite H Monett |
State: | MO US |
Postal Code: | 657089311 |
Phone Number: | 4176351177 |
Fax Number: | 4176351180 |
NPI Enumeration Date: | 03/25/2010 |
NPI Last Update Date: | 10/13/2010 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 261QR1300X |
License Number: | 114771 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | MO |
Taxonomy Type: | Ambulatory Health Care Facilities |
Taxonomy Classification: | Clinic/Center |
Taxonomy Specialization: | Rural Health |
Taxonomy Definition: |