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General NPI Number Information
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NPI Number | 1437835766
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Entity Type | Organization
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Legal Business Name | MORPHEUS IV HYDRATION & INFUSION
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Dates
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Enumeration Date | 06/22/2023
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Last Update Date | 06/22/2023
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Provider Practice Location Address
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Address Line | 3700 MONTEREY DR STE K
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City | COLUMBIA
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State | MO
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Zip | 65203-3694
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Country | US
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Telephone | 573-507-6580
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Fax |
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Provider Business Mailing Address
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Address Line | 3700 MONTEREY DR STE K
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City | COLUMBIA
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State | MO
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Zip | 65203-3694
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Country | US
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Telephone | 573-507-6580
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | JENNIFER CLARK
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Credential | CRNA
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Telephone | 573-507-6580
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QI0500X
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Taxonomy Name | Infusion Therapy Clinic/Center
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License Number |
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License Number State |
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