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General NPI Number Information
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NPI Number | 1336135607
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Entity Type | Organization
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Legal Business Name | MOBERLY MEDICAL CLINICS INC
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Dates
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Enumeration Date | 09/22/2005
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Last Update Date | 09/13/2021
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Provider Practice Location Address
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Address Line | 1513 UNION AVE SUITE 2300
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City | MOBERLY
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State | MO
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Zip | 65270-9407
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Country | US
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Telephone | 660-263-8309
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Fax | 660-263-1948
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Provider Business Mailing Address
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Address Line | 1515 UNION AVE
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City | MOBERLY
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State | MO
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Zip | 65270-9407
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Country | US
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Telephone | 660-269-3191
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Fax | 660-269-2943
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Authorized Official
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Title or Position | DIRECTOR OF PROVIDER ENROLLMENT
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Name | DEBBIE BREWER
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Credential |
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Telephone | 615-465-7626
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM1300X
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Taxonomy Name | Multi-Specialty Clinic/Center
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License Number |
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License Number State |
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