Healthcare Provider Details

I. General information

NPI: 1316207137
Provider Name (Legal Business Name): SUSAN ANNETTE PITTS D.O.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MISS SUSAN ANNETTE CHAPMAN

II. Dates (important events)

Enumeration Date: 05/26/2012
Last Update Date: 07/30/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 MERCY WAY
JOPLIN MO
64804
US

IV. Provider business mailing address

100 MERCY WAY
JOPLIN MO
64804-4524
US

V. Phone/Fax

Practice location:
  • Phone: 417-556-6428
  • Fax:
Mailing address:
  • Phone: 417-556-6428
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number5425
License Number StateOK
# 2
Primary TaxonomyY
Taxonomy Code2080N0001X
TaxonomyNeonatal-Perinatal Medicine Physician
License Number2018008658
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: