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General NPI Number Information
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NPI Number | 1043265986
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Entity Type | Organization
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Legal Business Name | BOLIVAR FAMILY CARE CENTER, LLC
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Dates
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Enumeration Date | 05/22/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 1240 N BUTTERFIELD RD
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City | BOLIVAR
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State | MO
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Zip | 65613-3016
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Country | US
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Telephone | 417-326-6021
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Fax | 417-326-6347
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Provider Business Mailing Address
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Address Line | 1240 N BUTTERFIELD RD
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City | BOLIVAR
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State | MO
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Zip | 65613-3016
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Country | US
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Telephone | 417-326-6021
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Fax | 417-326-6347
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Authorized Official
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Title or Position | ADMINISTRATOR
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Name | MR. WILLIAM FRANKLIN MARR
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Credential |
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Telephone | 417-326-6021
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number |
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License Number State |
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