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General NPI Number Information
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NPI Number | 1083643100
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Entity Type | Organization
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Legal Business Name | OSTEOPATHIC MEDICAL ARTS, LLC
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Dates
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Enumeration Date | 07/01/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 27176 ST HWY 6 E
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City | KIRKSVILLE
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State | MO
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Zip | 63501
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Country | US
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Telephone | 660-627-1812
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Fax | 660-627-4799
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Provider Business Mailing Address
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Address Line | PO BOX 661
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City | KIRKSVILLE
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State | MO
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Zip | 63501-0661
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Country | US
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Telephone | 660-627-1812
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Fax | 660-627-4799
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Authorized Official
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Title or Position | BOSS
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Name | DR. JERRY L HAMAN
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Credential | D.O
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Telephone | 660-627-1812
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 204D00000X
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Taxonomy Name | Neuromusculoskeletal Medicine & OMM Physician
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License Number |
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License Number State |
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