Healthcare Provider Details

I. General information

NPI: 1891088001
Provider Name (Legal Business Name): DOC IN A BOX LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/20/2011
Last Update Date: 12/07/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1000 WEBSTER STREET SUITE 101
MEXICO MO
65265
US

IV. Provider business mailing address

1000 WEBSTER STREET SUITE 101
MEXICO MO
65265-3298
US

V. Phone/Fax

Practice location:
  • Phone: 573-581-2348
  • Fax: 573-581-9447
Mailing address:
  • Phone: 573-581-2348
  • Fax: 573-581-9447

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QP2300X
TaxonomyPrimary Care Clinic/Center
License Number2009007879
License Number StateMO
# 2
Primary TaxonomyN
Taxonomy Code261QR1300X
TaxonomyRural Health Clinic/Center
License Number2009007879
License Number StateMO

VIII. Authorized Official

Name: DR. SCOTT PATRICK SIMMONS
Title or Position: OWNER
Credential: M.D.
Phone: 573-581-2348