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General NPI Number Information
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NPI Number | 1982069159
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Entity Type | Organization
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Legal Business Name | UNIVERSITY OF MISSOURI, COLUMBIA
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Dates
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Enumeration Date | 12/15/2015
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Last Update Date | 12/15/2015
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Provider Practice Location Address
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Address Line | 1 HOSPITAL DR # DC067.00
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City | COLUMBIA
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State | MO
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Zip | 65212-0001
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Country | US
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Telephone | 573-882-8907
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Fax |
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Provider Business Mailing Address
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Address Line | 4306 JEANA CT
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City | COLUMBIA
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State | MO
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Zip | 65203-6518
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | PROGRAM COORDINATOR
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Name | CYNTHIA MCCANN
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Credential |
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Telephone | 573-882-8907
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 283Q00000X
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Taxonomy Name | Psychiatric Hospital
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License Number | 2015040404
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License Number State | MO
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