Healthcare Provider Details

I. General information

NPI: 1780149336
Provider Name (Legal Business Name): HOLISTIC FAMILY MEDICINE AND OBSTETRICS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/07/2019
Last Update Date: 02/22/2022
Certification Date: 08/24/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

102 E WASHINGTON ST
MARSHALL MO
65340-2146
US

IV. Provider business mailing address

102 E WASHINGTON ST
MARSHALL MO
65340-2146
US

V. Phone/Fax

Practice location:
  • Phone: 660-333-3762
  • Fax: 877-975-1284
Mailing address:
  • Phone: 660-333-3762
  • Fax: 877-975-1284

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code171100000X
TaxonomyAcupuncturist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code207QA0401X
TaxonomyAddiction Medicine (Family Medicine) Physician
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code207VX0000X
TaxonomyObstetrics Physician
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number
License Number State
# 6
Primary TaxonomyY
Taxonomy Code261QP2300X
TaxonomyPrimary Care Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: JAMES TYLER MERCHANT
Title or Position: MANAGER
Credential: DO
Phone: 660-333-3762