Healthcare Provider Details

I. General information

NPI: 1083984074
Provider Name (Legal Business Name): LAUREN CLOUGH PRINGLE MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: LAUREN CLOUGH

II. Dates (important events)

Enumeration Date: 01/06/2012
Last Update Date: 10/02/2020
Certification Date: 10/02/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

ONE HOSPITAL DR
COLUMBIA MO
65212-0001
US

IV. Provider business mailing address

PO BOX 843966
KANSAS CITY MO
64184-3966
US

V. Phone/Fax

Practice location:
  • Phone: 573-882-2663
  • Fax: 573-884-4608
Mailing address:
  • Phone: 573-884-3300
  • Fax: 573-884-0943

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License NumberMD60913883
License Number StateWA
# 2
Primary TaxonomyN
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License NumberA153077
License Number StateCA
# 3
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number2020028192
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: