Healthcare Provider Details

I. General information

NPI: 1225682529
Provider Name (Legal Business Name): HAMLIN MEDICAL INNOVATIONS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/25/2019
Last Update Date: 07/08/2021
Certification Date: 06/14/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1001 W DAUGHERTY ST
WEBB CITY MO
64870-1717
US

IV. Provider business mailing address

6031 SOUTH MAIN STREET RD #334
WEBB CITY MO
64870-1717
US

V. Phone/Fax

Practice location:
  • Phone: 417-717-2017
  • Fax: 417-717-2134
Mailing address:
  • Phone: 417-548-3334
  • Fax: 417-548-3335

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: JUSTIN HAMLIN
Title or Position: OWNER
Credential: DO
Phone: 417-717-2017