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General NPI Number Information
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NPI Number | 1407711203
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Entity Type | Organization
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Legal Business Name | MISSOURI PIMC
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Dates
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Enumeration Date | 12/23/2025
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Last Update Date | 12/23/2025
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Provider Practice Location Address
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Address Line | 11416 S 44TH ST
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City | BELLEVUE
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State | NE
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Zip | 68123-1029
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Country | US
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Telephone | 661-345-5825
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Fax | 608-557-8410
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Provider Business Mailing Address
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Address Line | 11416 S 44TH ST
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City | BELLEVUE
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State | NE
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Zip | 68123-1029
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Country | US
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Telephone | 661-345-5825
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Fax | 608-557-8410
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Authorized Official
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Title or Position | ADMINISTRATIOR
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Name | JENNIFER LUND
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Credential |
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Telephone | 661-345-5835
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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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