Healthcare Provider Details

I. General information

NPI: 1669290623
Provider Name (Legal Business Name): ROMO DIRECT PRIMARY CARE, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/30/2024
Last Update Date: 09/30/2024
Certification Date: 09/30/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

706 S BISHOP AVE STE A
ROLLA MO
65401-4333
US

IV. Provider business mailing address

1028 S. BISHOP AVE PMB 201
ROLLA MO
65401
US

V. Phone/Fax

Practice location:
  • Phone: 573-995-2213
  • Fax: 573-240-9752
Mailing address:
  • Phone: 573-995-2213
  • Fax: 573-240-9752

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. STEPHANIE NICOLE HUHN
Title or Position: CEO
Credential: DO
Phone: 314-973-6261