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General NPI Number Information
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NPI Number | 1720401300
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Entity Type | Organization
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Legal Business Name | SEA A PC
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Dates
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Enumeration Date | 02/02/2014
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Last Update Date | 04/16/2014
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Provider Practice Location Address
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Address Line | 201 W BROADWAY BLDG 5 STE B
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City | COLUMBIA
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State | MO
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Zip | 65203-3842
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Country | US
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Telephone | 573-447-7477
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Fax | 573-777-3528
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Provider Business Mailing Address
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Address Line | 201 W BROADWAY BLDG 5 STE B
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City | COLUMBIA
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State | MO
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Zip | 65203-3842
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Country | US
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Telephone | 573-447-7477
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Fax | 573-777-3528
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Authorized Official
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Title or Position | OWNER AND CEO
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Name | DR. CHARLENE ADKINS
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Credential | MD
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Telephone | 573-489-1222
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207PH0002X
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Taxonomy Name | Hospice and Palliative Medicine (Emergency Medicine) Physician
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License Number | 100814
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License Number State | MO
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Taxonomy #2
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Taxonomy Code | 207P00000X
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Taxonomy Name | Emergency Medicine Physician
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License Number | 100814
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License Number State | MO
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