Healthcare Provider Details

I. General information

NPI: 1457422404
Provider Name (Legal Business Name): CURATORS OF THE UNIVERSITY OF MISSOURI
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/13/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

308 S CHURCH ST
FAYETTE MO
65248-1243
US

IV. Provider business mailing address

PO BOX 7687
COLUMBIA MO
65205-7687
US

V. Phone/Fax

Practice location:
  • Phone: 660-248-2217
  • Fax: 660-248-3450
Mailing address:
  • Phone: 573-882-8612
  • Fax: 573-884-4517

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM1300X
TaxonomyMulti-Specialty Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: JEFF CRAWFORD
Title or Position: ASSISTANT DIRECTOR
Credential:
Phone: 573-882-7767