Healthcare Provider Details

I. General information

NPI: 1902827512
Provider Name (Legal Business Name): MISSOURI VALLEY PHYSICIANS P C
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/21/2006
Last Update Date: 05/29/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2303 S. HWY 65
MARSHALL MO
65340
US

IV. Provider business mailing address

2303 S. HWY 65
MARSHALL MO
65340-3702
US

V. Phone/Fax

Practice location:
  • Phone: 660-886-3364
  • Fax: 660-886-6044
Mailing address:
  • Phone: 660-886-3364
  • Fax: 660-886-6044

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QR1300X
TaxonomyRural Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MRS. BRENDA L. BAIR
Title or Position: BRENDA BAIR, BUSINESS MANAGER
Credential:
Phone: 660-886-3364