Organization Name: | EXCELSIOR SPRINGS PHYSICIANS CLINIC |
NPI Number: | 1629491105 |
Entity Type Code: | Organizational (2) |
Authorized Official Name: | JENNIFER L BOOMGARDEN (PHYSICIANS PRACTICE MANAGER) |
Mailing Address: | 1700 Rainbow Blvd Excelsior Springs |
State: | MO US |
Postal Code: | 640241182 |
Phone Number: | 8166292623 |
Fax Number: | 8166292722 |
NPI Enumeration Date: | 02/04/2014 |
NPI Last Update Date: | 02/04/2014 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 207QA0000X |
License Number: | R6J43 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | MO |
Taxonomy Type: | Allopathic & Osteopathic Physicians |
Taxonomy Classification: | Family Medicine |
Taxonomy Specialization: | Adolescent Medicine |
Taxonomy Definition: | A family medicine physician with multidisciplinary training in the unique physical, psychological and social characteristics of adolescents and their health care problems and needs. |