Healthcare Provider Details

I. General information

NPI: 1538187711
Provider Name (Legal Business Name): ADRIAN CLINIC, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/17/2006
Last Update Date: 06/25/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

57 EAST MAIN STREET
ADRIAN MO
64720
US

IV. Provider business mailing address

PO BOX 7
ADRIAN MO
64720-0007
US

V. Phone/Fax

Practice location:
  • Phone: 816-297-8700
  • Fax: 816-297-8717
Mailing address:
  • Phone: 816-297-8700
  • Fax: 816-297-8717

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QR1300X
TaxonomyRural Health Clinic/Center
License Number
License Number StateMO
# 2
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number138659
License Number StateMO

VIII. Authorized Official

Name: MS. LAURA THIEM
Title or Position: OWNER
Credential: FNP-BC
Phone: 816-297-8700