Healthcare Provider Details

I. General information

NPI: 1578569372
Provider Name (Legal Business Name): CENTRALIA FAMILY HEALTH, PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/27/2005
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1021 E HIGHWAY 22
CENTRALIA MO
65240-1183
US

IV. Provider business mailing address

4700 FORUM BLVD
COLUMBIA MO
65203-5654
US

V. Phone/Fax

Practice location:
  • Phone: 573-682-5588
  • Fax: 573-682-1539
Mailing address:
  • Phone: 573-449-4936
  • Fax: 573-449-6795

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: DR. CURTIS D. KING
Title or Position: PHYSICIAN
Credential: M.D.
Phone: 573-682-5588