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General NPI Number Information
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NPI Number | 1063785442
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Entity Type | Organization
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Legal Business Name | SPECTRUM HEALTH CARE
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Dates
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Enumeration Date | 02/16/2012
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Last Update Date | 01/05/2024
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Provider Practice Location Address
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Address Line | 1123 WILKES BLVD STE 110
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City | COLUMBIA
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State | MO
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Zip | 65201-4774
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Country | US
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Telephone | 573-514-7312
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Fax | 573-242-6427
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Provider Business Mailing Address
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Address Line | 1123 WILKES BLVD STE 100
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City | COLUMBIA
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State | MO
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Zip | 65201-4774
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Country | US
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Telephone | 573-514-7312
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Fax | 573-242-6336
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Authorized Official
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Title or Position | PROGRAM MANAGER
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Name | SHAWNA WOOFTER
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Credential |
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Telephone | 573-514-7312
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 164W00000X
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Taxonomy Name | Licensed Practical Nurse
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 261QF0050X
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Taxonomy Name | Non-Surgical Family Planning Clinic/Center
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 261QH0100X
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Taxonomy Name | Health Service Clinic/Center
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License Number |
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License Number State |
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Taxonomy #4
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Taxonomy Code | 261QR1300X
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Taxonomy Name | Rural Health Clinic/Center
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License Number |
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License Number State |
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Taxonomy #5
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Taxonomy Code | 251K00000X
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Taxonomy Name | Public Health or Welfare Agency
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License Number |
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License Number State |
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