Healthcare Provider Details

I. General information

NPI: 1578594800
Provider Name (Legal Business Name): AMY BELVILLE DO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/05/2006
Last Update Date: 08/14/2020
Certification Date: 08/14/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3107 FREDRICK AVE , STE B SUITE 250
SAINT JOSEPH MO
64506
US

IV. Provider business mailing address

3107 FREDRICK AVE , STE B SUITE 250
SAINT JOSEPH MO
64506
US

V. Phone/Fax

Practice location:
  • Phone: 816-233-9888
  • Fax: 816-233-0414
Mailing address:
  • Phone: 816-233-9888
  • Fax: 816-233-0414

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208100000X
TaxonomyPhysical Medicine & Rehabilitation Physician
License Number2003013938
License Number StateMO
# 2
Primary TaxonomyY
Taxonomy Code204R00000X
TaxonomyElectrodiagnostic Medicine Physician
License Number2003013938
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: