Healthcare Provider Details

I. General information

NPI: 1982682597
Provider Name (Legal Business Name): CHARLES W CUNNINGHAM DO LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/04/2006
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1010 W HIGHWAY 32
SALEM MO
65560-2356
US

IV. Provider business mailing address

1010 W HIGHWAY 32 P.O. BOX 399
SALEM MO
65560-2356
US

V. Phone/Fax

Practice location:
  • Phone: 572-729-5533
  • Fax: 573-729-7754
Mailing address:
  • Phone: 572-729-5533
  • Fax: 573-729-7754

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number33540
License Number StateMO
# 2
Primary TaxonomyN
Taxonomy Code261QR1300X
TaxonomyRural Health Clinic/Center
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number121934
License Number StateMO

VIII. Authorized Official

Name: DR. CHARLES W CUNNINGHAM
Title or Position: OWNER
Credential: D.O.
Phone: 573-729-5533