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General NPI Number Information
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NPI Number | 1497908842
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Entity Type | Organization
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Legal Business Name | MISSOURI SOUTHERN STATE UNIVERSITY HEALTH CENTER
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Dates
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Enumeration Date | 10/29/2008
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Last Update Date | 10/29/2008
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Provider Practice Location Address
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Address Line | 3950 NEWMAN RD KUHN HALL 306 HEALTH SERVICES OFFICE
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City | JOPLIN
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State | MO
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Zip | 64801-1512
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Country | US
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Telephone | 417-625-9323
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Fax | 417-659-4376
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Provider Business Mailing Address
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Address Line | 3950 NEWMAN RD KUHN HALL 306 HEALTH SERVICES OFFICE
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City | JOPLIN
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State | MO
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Zip | 64801-1512
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Country | US
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Telephone | 417-625-9323
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Fax | 417-659-4376
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Authorized Official
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Title or Position | DIRECTOR OF HEALTH CARE SERVICES
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Name | MS. W JANICE DIPLEY
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Credential | FNP
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Telephone | 417-625-9323
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QS1000X
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Taxonomy Name | Student Health Clinic/Center
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License Number | 1072289
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License Number State | MO
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