=====================================================
General NPI Number Information
=====================================================
NPI Number | 1326379710
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | JOPLIN PRIMARY CARE INC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/25/2010
-----------------------------------------------------
Last Update Date | 05/12/2010
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 3130 WISCONSIN AVE STE 4
-----------------------------------------------------
City | JOPLIN
-----------------------------------------------------
State | MO
-----------------------------------------------------
Zip | 64804-2873
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 417-206-4300
-----------------------------------------------------
Fax | 417-206-9306
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 2009
-----------------------------------------------------
City | JOPLIN
-----------------------------------------------------
State | MO
-----------------------------------------------------
Zip | 64803-2009
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 417-206-4300
-----------------------------------------------------
Fax | 417-206-9306
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | MD
-----------------------------------------------------
Name | DR. SEAN C PFEFFER
-----------------------------------------------------
Credential | MD
-----------------------------------------------------
Telephone | 417-206-4300
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207Q00000X
-----------------------------------------------------
Taxonomy Name | Family Medicine Physician
-----------------------------------------------------
License Number | 2003026619
-----------------------------------------------------
License Number State | MO
-----------------------------------------------------