Healthcare Provider Details

I. General information

NPI: 1851015986
Provider Name (Legal Business Name): COMPREHENSIVE MEDICAL AND INFUSION CENTER LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/03/2022
Last Update Date: 01/18/2023
Certification Date: 01/18/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

809 MEDICAL PARK DR STE 103
MEXICO MO
65265-3753
US

IV. Provider business mailing address

601 SAHALEE CT
COLUMBIA MO
65201-2964
US

V. Phone/Fax

Practice location:
  • Phone: 573-581-3991
  • Fax:
Mailing address:
  • Phone: 573-581-3991
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RH0003X
TaxonomyHematology & Oncology Physician
License Number
License Number State

VIII. Authorized Official

Name: SHAHID WAHEED
Title or Position: AUTHORIZED OFFICIAL
Credential: MD
Phone: 573-473-4020