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General NPI Number Information
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NPI Number | 1659143253
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Entity Type | Organization
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Legal Business Name | MO C&P LLC
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Dates
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Enumeration Date | 10/26/2023
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Last Update Date | 10/26/2023
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Provider Practice Location Address
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Address Line | 3050 S NATIONAL AVE STE 105
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City | SPRINGFIELD
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State | MO
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Zip | 65804-4242
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Country | US
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Telephone | 417-771-7741
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Fax |
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Provider Business Mailing Address
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Address Line | 3050 S NATIONAL AVE STE 105
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City | SPRINGFIELD
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State | MO
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Zip | 65804-4242
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Country | US
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Telephone | 417-771-7741
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Fax |
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Authorized Official
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Title or Position | EXECUTIVE OFFICER
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Name | DR. ERIC CHAVEZ
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Credential | DMSC, PA-C
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Telephone | 417-425-8521
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QV0200X
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Taxonomy Name | VA Clinic/Center
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License Number |
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License Number State |
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