Healthcare Provider Details

I. General information

NPI: 1720401300
Provider Name (Legal Business Name): SEA A PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/02/2014
Last Update Date: 04/16/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

201 W BROADWAY BLDG 5 STE B
COLUMBIA MO
65203-3842
US

IV. Provider business mailing address

201 W BROADWAY BLDG 5 STE B
COLUMBIA MO
65203-3842
US

V. Phone/Fax

Practice location:
  • Phone: 573-447-7477
  • Fax: 573-777-3528
Mailing address:
  • Phone: 573-447-7477
  • Fax: 573-777-3528

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207PH0002X
TaxonomyHospice and Palliative Medicine (Emergency Medicine) Physician
License Number100814
License Number StateMO
# 2
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number100814
License Number StateMO

VIII. Authorized Official

Name: DR. CHARLENE ADKINS
Title or Position: OWNER AND CEO
Credential: MD
Phone: 573-489-1222