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General NPI Number Information
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NPI Number | 1144004821
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Entity Type | Organization
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Legal Business Name | ZIVA MEDICAL PRIMARY CARE LLC
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Dates
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Enumeration Date | 08/23/2023
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Last Update Date | 08/23/2023
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Provider Practice Location Address
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Address Line | 515 E PROMENADE ST STE 1
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City | MEXICO
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State | MO
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Zip | 65265-2966
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Country | US
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Telephone | 573-570-3520
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 197
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City | LAKEWOOD
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State | NJ
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Zip | 08701-0197
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | CEO
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Name | AMANDA SHURTZ
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Credential |
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Telephone | 573-570-3555
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QP2300X
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Taxonomy Name | Primary Care Clinic/Center
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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 | 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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