=====================================================
General NPI Number Information
=====================================================
NPI Number | 1306043799
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | KEVIN NANCE BARTOW MD
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/28/2007
-----------------------------------------------------
Last Update Date | 11/21/2022
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | ONE HOSPITAL DR
-----------------------------------------------------
City | COLUMBIA
-----------------------------------------------------
State | MO
-----------------------------------------------------
Zip | 65212-0001
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 573-882-2100
-----------------------------------------------------
Fax | 573-884-0437
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 60 DOCTORS PARK
-----------------------------------------------------
City | CAPE GIRARDEAU
-----------------------------------------------------
State | MO
-----------------------------------------------------
Zip | 63703-4928
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 573-334-3074
-----------------------------------------------------
Fax | 573-334-5554
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 208600000X
-----------------------------------------------------
Taxonomy Name | Surgery Physician
-----------------------------------------------------
License Number | 2012012177
-----------------------------------------------------
License Number State | MO
-----------------------------------------------------