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General NPI Number Information
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NPI Number | 1255728226
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Entity Type | Organization
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Legal Business Name | HARRY S. TRUMAN MVH
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Dates
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Enumeration Date | 04/17/2015
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Last Update Date | 04/17/2015
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Provider Practice Location Address
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Address Line | 132 SOUTHAMPTON DR
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City | COLUMBIA
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State | MO
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Zip | 65203-3050
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Country | US
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Telephone | 419-822-6931
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Fax |
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Provider Business Mailing Address
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Address Line | 132 SOUTHAMPTON DR
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City | COLUMBIA
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State | MO
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Zip | 65203-3050
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Country | US
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Telephone | 419-822-6931
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Fax |
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Authorized Official
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Title or Position | DIAGNOSTIC RADIOLOGY TECH
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Name | DANIEL GRACIA
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Credential |
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Telephone | 419-822-6931
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QR0200X
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Taxonomy Name | Radiology Clinic/Center
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License Number | 508605
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License Number State |
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