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General NPI Number Information
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NPI Number | 1891088001
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Entity Type | Organization
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Legal Business Name | DOC IN A BOX LLC
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Dates
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Enumeration Date | 05/20/2011
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Last Update Date | 12/07/2015
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Provider Practice Location Address
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Address Line | 1000 WEBSTER STREET SUITE 101
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City | MEXICO
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State | MO
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Zip | 65265
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Country | US
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Telephone | 573-581-2348
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Fax | 573-581-9447
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Provider Business Mailing Address
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Address Line | 1000 WEBSTER STREET SUITE 101
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City | MEXICO
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State | MO
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Zip | 65265-3298
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Country | US
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Telephone | 573-581-2348
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Fax | 573-581-9447
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Authorized Official
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Title or Position | OWNER
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Name | DR. SCOTT PATRICK SIMMONS
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Credential | M.D.
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Telephone | 573-581-2348
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QR1300X
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Taxonomy Name | Rural Health Clinic/Center
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License Number | 2009007879
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License Number State | MO
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Taxonomy #2
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Taxonomy Code | 261QP2300X
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Taxonomy Name | Primary Care Clinic/Center
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License Number | 2009007879
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License Number State | MO
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