Healthcare Provider Details

I. General information

NPI: 1396591202
Provider Name (Legal Business Name): HEALTH-1 LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/30/2024
Last Update Date: 12/03/2024
Certification Date: 12/03/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1000 W NIFONG BLVD STE 120
COLUMBIA MO
65203-5615
US

IV. Provider business mailing address

1000 W NIFONG BLVD STE 120
COLUMBIA MO
65203-5615
US

V. Phone/Fax

Practice location:
  • Phone: 573-444-6331
  • Fax: 855-576-4137
Mailing address:
  • Phone: 573-444-6331
  • Fax: 855-576-4137

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: JOHN FERNANDO
Title or Position: OWNER
Credential:
Phone: 573-355-2429