Healthcare Provider Details

I. General information

NPI: 1861577942
Provider Name (Legal Business Name): CENTRAL MO WOMENS HEALTHCARE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/26/2006
Last Update Date: 06/19/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

268 S JEFFERSON
MARSHALL MO
65340-2135
US

IV. Provider business mailing address

268 S JEFFERSON AVE
MARSHALL MO
65340
US

V. Phone/Fax

Practice location:
  • Phone: 660-886-2842
  • Fax:
Mailing address:
  • Phone: 660-886-2842
  • Fax: 660-886-8119

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number105156
License Number StateMO

VIII. Authorized Official

Name: MICHELLE MCCOY
Title or Position: CFO/OFFICE MANAGER
Credential:
Phone: 660-886-2842