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General NPI Number Information
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NPI Number | 1831269695
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Entity Type | Organization
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Legal Business Name | MID-MISSOURI NEONATOLOGY LLC
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Dates
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Enumeration Date | 11/09/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 1600 E BROADWAY
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City | COLUMBIA
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State | MO
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Zip | 65201-5844
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Country | US
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Telephone | 573-815-3737
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Fax | 573-815-3716
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Provider Business Mailing Address
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Address Line | PO BOX 10200
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City | COLUMBIA
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State | MO
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Zip | 65205-4003
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Country | US
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Telephone | 573-815-9700
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Fax | 573-815-0700
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Authorized Official
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Title or Position | INSURANCE AND BILLING SPECIALIST
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Name | MS. BRENDA LEE WILSON
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Credential |
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Telephone | 573-815-9700
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2080N0001X
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Taxonomy Name | Neonatal-Perinatal Medicine Physician
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License Number |
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License Number State |
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