Healthcare Provider Details

I. General information

NPI: 1770599581
Provider Name (Legal Business Name): UNIVERSITY OF CENTRAL MISSOURI STUDENT HEALTH CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/01/2006
Last Update Date: 12/10/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

600 S COLLEGE AVE
WARRENSBURG MO
64093-2621
US

IV. Provider business mailing address

PO BOX 5199
ABILENE TX
79608-5199
US

V. Phone/Fax

Practice location:
  • Phone: 660-543-4770
  • Fax: 660-543-8222
Mailing address:
  • Phone: 866-890-6390
  • Fax: 325-437-8390

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: GERIANNE BLISS
Title or Position: CHIEF PHYSICIAN
Credential: MD
Phone: 660-543-4770