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General NPI Number Information
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NPI Number | 1710320643
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Entity Type | Organization
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Legal Business Name | A PATTERN HEALTH CLINIC, INC
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Dates
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Enumeration Date | 04/10/2013
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Last Update Date | 06/01/2015
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Provider Practice Location Address
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Address Line | 1674 S ODELL AVE
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City | MARSHALL
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State | MO
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Zip | 65340-3365
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Country | US
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Telephone | 660-886-9852
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Fax | 816-787-1368
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Provider Business Mailing Address
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Address Line | 1674 SOUTH ODELL AVE
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City | MARSHALL
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State | MO
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Zip | 65340
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Country | US
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Telephone | 660-886-9852
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Fax | 816-787-1368
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Authorized Official
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Title or Position | PRESIDENT
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Name | ANNEX LUBERISSE
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Credential |
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Telephone | 660-886-9852
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261Q00000X
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Taxonomy Name | Clinic/Center
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License Number | 01272547
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License Number State | MO
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