Healthcare Provider Details

I. General information

NPI: 1275898017
Provider Name (Legal Business Name): ANA RIVAS MEJIA MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/09/2012
Last Update Date: 09/24/2020
Certification Date: 09/24/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

960 E. WALNUT LAWN STREET SUITE 201
SPRINGFIELD MO
65807-7865
US

IV. Provider business mailing address

14502 W MEEKER BLVD
SUN CITY WEST AZ
85375-5282
US

V. Phone/Fax

Practice location:
  • Phone: 417-269-4450
  • Fax: 417-269-8333
Mailing address:
  • Phone: 623-524-8814
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RE0101X
TaxonomyEndocrinology, Diabetes & Metabolism Physician
License NumberR0648
License Number StateTX
# 2
Primary TaxonomyY
Taxonomy Code207RE0101X
TaxonomyEndocrinology, Diabetes & Metabolism Physician
License Number2020012850
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: