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General NPI Number Information
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NPI Number | 1992615371
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Entity Type | Organization
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Legal Business Name | MISSOURI VALLEY MEDICAL CENTER, LLC
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Dates
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Enumeration Date | 09/09/2026
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Last Update Date | 09/09/2026
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Provider Practice Location Address
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Address Line | 2303 S HIGHWAY 65
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City | MARSHALL
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State | MO
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Zip | 65340-3734
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Country | US
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Telephone | 660-886-7800
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Fax | 660-886-6044
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Provider Business Mailing Address
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Address Line | 1869 CRAIG PARK CT
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City | SAINT LOUIS
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State | MO
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Zip | 63146-4122
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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 | AUTHORIZED SIGNATORY
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Name | NICHOLAS DESTEFANE
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Credential |
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Telephone | 314-543-3800
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM1300X
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Taxonomy Name | Multi-Specialty Clinic/Center
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License Number |
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License Number State |
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