Healthcare Provider Details

I. General information

NPI: 1831141837
Provider Name (Legal Business Name): VIENNA HEALTH CARE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/17/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

606 HIGHWAY 63 S
VIENNA MO
65582-8101
US

IV. Provider business mailing address

PO BOX 715
VIENNA MO
65582-0715
US

V. Phone/Fax

Practice location:
  • Phone: 573-422-3636
  • Fax: 573-422-3434
Mailing address:
  • Phone: 573-422-3636
  • Fax: 573-422-3434

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number2006002908
License Number StateMO

VIII. Authorized Official

Name: KIMBERLY DENIESE BOHLMANN
Title or Position: PHYSICAN
Credential: M.D.
Phone: 573-422-3636