=====================================================
General NPI Number Information
=====================================================
NPI Number | 1427583418
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | CURATORS OF THE UNIVERSITY OF MISSOURI
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 04/27/2017
-----------------------------------------------------
Last Update Date | 05/13/2019
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 101 REDTAIL DR STE C
-----------------------------------------------------
City | ASHLAND
-----------------------------------------------------
State | MO
-----------------------------------------------------
Zip | 65010-1140
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 573-882-9060
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 843966
-----------------------------------------------------
City | KANSAS CITY
-----------------------------------------------------
State | MO
-----------------------------------------------------
Zip | 64184-3966
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 573-882-3974
-----------------------------------------------------
Fax | 573-884-0943
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | EXECUTIVE DIRECTOR
-----------------------------------------------------
Name | VICTOR ARNOLD
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 573-882-1612
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207Q00000X
-----------------------------------------------------
Taxonomy Name | Family Medicine Physician
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------