MEDICARE: JULIA E MCNABB, D.O. LLC

Medicare Provider Information

Scope of Practice

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

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261QP2300X	Primary Care Clinic/Center

General Provider Information

NPI Number	:	1154525053
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	JULIA E MCNABB, D.O. LLC

Provider Business Mailing Address
First Line	:	PO BOX 40
Second Line	:
City	:	QUEEN CITY
State	:	MO
Zip	:	63561-0040
Country	:	US
Telephone Number	:	660-766-2300
Fax Number	:	626-593-4791

Provider Business Practice Location Address
First Line	:	513 N OLIVE ST
Second Line	:
City	:	QUEEN CITY
State	:	MO
Zip	:	63561-1054
Country	:	US
Telephone Number	:	660-766-2300
Fax Number	:	626-593-4791

Authorized Official
Title or Position	:	OWNER
Name	:	DR. JULIA E MCNABB
Credential	:	D.O.
Telephone Number	:	660-626-5413

Provider Enumeration Date	:	06/13/2007
Last Update Date	:	10/25/2021

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