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General NPI Number Information
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NPI Number | 1144693870
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Entity Type | Organization
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Legal Business Name | ULBRICH FAMILY MEDICINE, LLC
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Dates
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Enumeration Date | 11/03/2015
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Last Update Date | 12/22/2015
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Provider Practice Location Address
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Address Line | 2301 S HIGHWAY 65 SUITE 2
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City | MARSHALL
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State | MO
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Zip | 65340-3702
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Country | US
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Telephone | 660-631-3386
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Fax |
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Provider Business Mailing Address
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Address Line | 2301 S HIGHWAY 65 SUITE 2
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City | MARSHALL
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State | MO
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Zip | 65340-3702
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Country | US
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Telephone | 660-631-3386
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | JAMIE GRANT ULBRICH
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Credential | MD
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Telephone | 660-631-3386
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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 | MD105523
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License Number State | MO
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