Healthcare Provider Details

I. General information

NPI: 1497908842
Provider Name (Legal Business Name): MISSOURI SOUTHERN STATE UNIVERSITY HEALTH CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/29/2008
Last Update Date: 10/29/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3950 NEWMAN RD KUHN HALL 306 HEALTH SERVICES OFFICE
JOPLIN MO
64801-1512
US

IV. Provider business mailing address

3950 NEWMAN RD KUHN HALL 306 HEALTH SERVICES OFFICE
JOPLIN MO
64801-1512
US

V. Phone/Fax

Practice location:
  • Phone: 417-625-9323
  • Fax: 417-659-4376
Mailing address:
  • Phone: 417-625-9323
  • Fax: 417-659-4376

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QS1000X
TaxonomyStudent Health Clinic/Center
License Number1072289
License Number StateMO

VIII. Authorized Official

Name: MS. W JANICE DIPLEY
Title or Position: DIRECTOR OF HEALTH CARE SERVICES
Credential: FNP
Phone: 417-625-9323