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General NPI Number Information
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NPI Number | 1114116605
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Entity Type | Organization
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Legal Business Name | CHARLES J. MCMULLIN
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Dates
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Enumeration Date | 10/19/2007
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Last Update Date | 10/19/2007
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Provider Practice Location Address
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Address Line | 54 HOSPITAL DR SUITE 205
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City | OSAGE BEACH
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State | MO
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Zip | 65065-3050
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Country | US
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Telephone | 573-302-2276
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Fax |
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Provider Business Mailing Address
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Address Line | 54 HOSPITAL DR STE 205
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City | OSAGE BEACH
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State | MO
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Zip | 65065-3050
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Country | US
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Telephone | 573-302-2276
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Fax |
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Authorized Official
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Title or Position | BILLING MANAGER
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Name | MISS BETH E. CARLILE
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Credential |
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Telephone | 573-364-2227
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number | MD117270
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License Number State | MO
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