Healthcare Provider Details

I. General information

NPI: 1629290002
Provider Name (Legal Business Name): JOHN C VANSTONE MD PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/03/2007
Last Update Date: 10/22/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3300 LEMONE INDUSTRIAL BLVD
COLUMBIA MO
65201
US

IV. Provider business mailing address

2109 DICKINSON CT
COLUMBIA MO
65202
US

V. Phone/Fax

Practice location:
  • Phone: 573-443-1531
  • Fax:
Mailing address:
  • Phone: 573-814-2255
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RN0300X
TaxonomyNephrology Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. JOHN C VANSTONE
Title or Position: PRESIDENT
Credential: MD
Phone: 573-443-1531