Organization Name: | MOBERLY MEDICAL CLINICS INC |
NPI Number: | 1336135607 |
Entity Type Code: | Organizational (2) |
Authorized Official Name: | DEBBIE BREWER (DIRECTOR OF PROVIDER ENROLLMENT) |
Mailing Address: | 1513 Union Ave Suite 2300 Moberly |
State: | MO US |
Postal Code: | 652709407 |
Phone Number: | 6602638309 |
Fax Number: | 6602631948 |
NPI Enumeration Date: | 09/22/2005 |
NPI Last Update Date: | 12/31/2007 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 261QM1300X |
License Number: | |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | |
Taxonomy Type: | Ambulatory Health Care Facilities |
Taxonomy Classification: | Clinic/Center |
Taxonomy Specialization: | Multi-Specialty |
Taxonomy Definition: |