MEDICARE: MOBERLY MEDICAL CLINICS INC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number State
1	207R00000X	Internal Medicine Physician	MO
2	207RP1001X	Pulmonary Disease Physician	MO
3	208000000X	Pediatrics Physician	MO
4	363A00000X	Physician Assistant	MO
5	363LF0000X	Family Nurse Practitioner	MO
6	207Q00000X	Family Medicine Physician	MO

General Provider Information

NPI Number	:	1124238555
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MOBERLY MEDICAL CLINICS INC

Provider Business Mailing Address
First Line	:	136 SHELBY PLAZA RD
Second Line	:
City	:	SHELBINA
State	:	MO
Zip	:	63468-1065
Country	:	US
Telephone Number	:	573-588-1111
Fax Number	:	573-588-1114

Provider Business Practice Location Address
First Line	:	136 SHELBY PLAZA RD
Second Line	:
City	:	SHELBINA
State	:	MO
Zip	:	63468-1065
Country	:	US
Telephone Number	:	573-588-1111
Fax Number	:	573-588-1114

Authorized Official
Title or Position	:	DIRECTOR OF PROVIDER ENROLLMENT
Name	:	DEBBIE BREWER
Credential	:
Telephone Number	:	615-465-7626

Provider Enumeration Date	:	05/23/2007
Last Update Date	:	07/21/2022

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Directions to “MOBERLY MEDICAL CLINICS INC ” Practice Location

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