Healthcare Provider Details

I. General information

NPI: 1811015902
Provider Name (Legal Business Name): THYMIOS P LAMBROU LILBOURN MEDICAL CLINIC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/27/2007
Last Update Date: 06/17/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

537 W YOAKUM AVE
CHAFFEE MO
63740-1825
US

IV. Provider business mailing address

537 W YOAKUM AVE
CHAFFEE MO
63740-1825
US

V. Phone/Fax

Practice location:
  • Phone: 573-887-3010
  • Fax: 573-887-3004
Mailing address:
  • Phone: 573-887-3010
  • Fax: 573-887-3004

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QR1300X
TaxonomyRural Health Clinic/Center
License Number
License Number StateMO

VIII. Authorized Official

Name: THYMIOS P LAMBROU
Title or Position: OWNER
Credential: M.D.
Phone: 573-887-3010