Healthcare Provider Details

I. General information

NPI: 1679980502
Provider Name (Legal Business Name): REPUBLIC FAMILY MEDICINE, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/11/2014
Last Update Date: 10/02/2023
Certification Date: 10/02/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

117 W STATE HIGHWAY 174
REPUBLIC MO
65738-1036
US

IV. Provider business mailing address

117 W STATE HIGHWAY 174
REPUBLIC MO
65738-1036
US

V. Phone/Fax

Practice location:
  • Phone: 417-647-5131
  • Fax: 417-647-5168
Mailing address:
  • Phone: 417-647-5131
  • Fax: 417-647-5168

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. YVONNE MARIE AGIUS
Title or Position: MEMBER
Credential: M.D.
Phone: 417-824-0914