Healthcare Provider Details

I. General information

NPI: 1588193643
Provider Name (Legal Business Name): KATHLEEN JANE MCGUIRE DO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/12/2017
Last Update Date: 06/12/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 HOSPITAL DR
COLUMBIA MO
65212-1000
US

IV. Provider business mailing address

1 HOSPITAL DRIVE DCO67.00
COLUMBIA MO
65212
US

V. Phone/Fax

Practice location:
  • Phone: 573-882-8907
  • Fax: 573-884-1070
Mailing address:
  • Phone: 573-882-8907
  • Fax: 573-884-1070

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number2017018890
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: