Healthcare Provider Details

I. General information

NPI: 1639888647
Provider Name (Legal Business Name): MO C&P LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/17/2022
Last Update Date: 11/17/2022
Certification Date: 11/17/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1925 E BENNETT ST STE I
SPRINGFIELD MO
65804-1425
US

IV. Provider business mailing address

1229 S JEFFERSON AVE
SPRINGFIELD MO
65807-1603
US

V. Phone/Fax

Practice location:
  • Phone: 417-425-8521
  • Fax:
Mailing address:
  • Phone: 417-425-8521
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QV0200X
TaxonomyVA Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DR. ERIC CHAVEZ
Title or Position: PRESIDENT
Credential: DMSC, PA-C
Phone: 417-425-8521