Healthcare Provider Details

I. General information

NPI: 1366234767
Provider Name (Legal Business Name): COLUMBIA SKILLED NURSING ASSOCIATES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/21/2025
Last Update Date: 09/29/2025
Certification Date: 09/29/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3535 BERRYWOOD DR
COLUMBIA MO
65201-6584
US

IV. Provider business mailing address

PO BOX 30860
COLUMBIA MO
65205-3860
US

V. Phone/Fax

Practice location:
  • Phone: 573-819-8205
  • Fax:
Mailing address:
  • Phone: 573-819-8205
  • Fax: 636-333-4510

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code363LG0600X
TaxonomyGerontology Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: DAVID T JAMES III
Title or Position: PARTNER, OWNER
Credential: MD
Phone: 573-819-8205