Healthcare Provider Details

I. General information

NPI: 1083643100
Provider Name (Legal Business Name): OSTEOPATHIC MEDICAL ARTS, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/01/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

27176 ST HWY 6 E
KIRKSVILLE MO
63501
US

IV. Provider business mailing address

PO BOX 661
KIRKSVILLE MO
63501-0661
US

V. Phone/Fax

Practice location:
  • Phone: 660-627-1812
  • Fax: 660-627-4799
Mailing address:
  • Phone: 660-627-1812
  • Fax: 660-627-4799

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code204D00000X
TaxonomyNeuromusculoskeletal Medicine & OMM Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. JERRY L HAMAN
Title or Position: BOSS
Credential: D.O
Phone: 660-627-1812