Healthcare Provider Details

I. General information

NPI: 1710383435
Provider Name (Legal Business Name): EPOCH - CENTRAL MISSOURI LIMITED LIABILITY COMPANY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/06/2014
Last Update Date: 09/29/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2900 TRIMBLE RD.
COLUMBIA MO
65201-6465
US

IV. Provider business mailing address

2900 TRIMBLE RD.
COLUMBIA MO
65201-6465
US

V. Phone/Fax

Practice location:
  • Phone: 573-818-3067
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number
License Number State

VIII. Authorized Official

Name: STEVE HOUSE
Title or Position: AUTHORIZED OFFICIAL
Credential:
Phone: 817-239-9801