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General NPI Number Information
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NPI Number | 1295699486
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Entity Type | Organization
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Legal Business Name | BOONE PHYSICIAN SERVICES, LLC
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Dates
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Enumeration Date | 12/11/2025
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Last Update Date | 12/11/2025
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Provider Practice Location Address
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Address Line | 1605 E BROADWAY STE 200
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City | COLUMBIA
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State | MO
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Zip | 65201-8023
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Country | US
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Telephone | 573-815-8000
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Fax |
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Provider Business Mailing Address
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Address Line | 1600 E BROADWAY
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City | COLUMBIA
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State | MO
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Zip | 65201-5844
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Country | US
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Telephone | 573-815-8000
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Fax |
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Authorized Official
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Title or Position | CHIEF FINANCIAL OFFICER
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Name | EDWARD JAMES CLAYTON JR.
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Credential |
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Telephone | 573-815-3072
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208600000X
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Taxonomy Name | Surgery Physician
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License Number |
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License Number State |
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