| Organization Name: | HANNIBAL CLINIC OPERATIONS, L.L.C |
| NPI Number: | 1427037225 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | MICHAEL J. BUKSTEIN (PRESIDENT/CEO) |
| Mailing Address: | 100 Medical Dr Hannibal |
| State: | MO US |
| Postal Code: | 634016877 |
| Phone Number: | 5732215250 |
| Fax Number: | 5732313706 |
| NPI Enumeration Date: | 01/11/2006 |
| NPI Last Update Date: | 05/13/2009 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 208D00000X |
| License Number: | |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | |
| Taxonomy Type: | Allopathic & Osteopathic Physicians |
| Taxonomy Classification: | General Practice |
| Taxonomy Specialization: | |
| Taxonomy Definition: | |