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General NPI Number Information
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NPI Number | 1124263900
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Entity Type | Organization
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Legal Business Name | TO YOUR HEALTH MEDICAL CLINIC, INC
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Dates
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Enumeration Date | 12/09/2008
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Last Update Date | 06/12/2009
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Provider Practice Location Address
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Address Line | 2614 FORUM BOULEVARD SUITE 100
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City | COLUMBIA
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State | MO
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Zip | 65203
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Country | US
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Telephone | 573-445-3430
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Fax | 573-445-3460
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Provider Business Mailing Address
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Address Line | 2614 FORUM BOULEVARD SUITE 100
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City | COLUMBIA
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State | MO
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Zip | 65203
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Country | US
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Telephone | 573-445-3430
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Fax | 573-445-3460
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Authorized Official
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Title or Position | DIRECTOR OF OPERATIONS
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Name | DR. ABDOULAYE BAH
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Credential |
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Telephone | 573-445-3430
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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 | 2000161132
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License Number State | MO
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