Healthcare Provider Details

I. General information

NPI: 1770507287
Provider Name (Legal Business Name): ASSOCIATES IN MEDICINE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/27/2006
Last Update Date: 09/18/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

630 E BUFFALO ST
BOLIVAR MO
65613-2619
US

IV. Provider business mailing address

PO BOX 536
BOLIVAR MO
65613-0536
US

V. Phone/Fax

Practice location:
  • Phone: 417-777-4749
  • Fax: 417-777-8041
Mailing address:
  • Phone: 417-777-4749
  • Fax: 417-777-8041

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberD0101186
License Number StateMO

VIII. Authorized Official

Name: GREGORY S ZOLKOWSKI
Title or Position: PHYSICIAN / OWNER
Credential: DO
Phone: 417-777-4749