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General NPI Number Information
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NPI Number | 1508310293
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Entity Type | Organization
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Legal Business Name | SUCCESS HEALTH SYSTEM, LLC
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Dates
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Enumeration Date | 08/10/2016
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Last Update Date | 09/30/2025
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Provider Practice Location Address
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Address Line | 3600 INTERSTATE 70 DR SE STE C
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City | COLUMBIA
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State | MO
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Zip | 65201-6583
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Country | US
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Telephone | 888-410-5230
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 716
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City | COLUMBIA
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State | MO
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Zip | 65205-0716
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Country | US
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Telephone | 972-974-0109
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Fax | 573-271-5108
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Authorized Official
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Title or Position | MD
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Name | MR. MOSES TABE AMBILICHU
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Credential | M.D.
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Telephone | 972-974-0109
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2084P0800X
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Taxonomy Name | Psychiatry Physician
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License Number |
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License Number State |
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