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NPI Code Detail

MEDICARE: DALE FAMILY MEDICINE

MEDICARE: DALE FAMILY MEDICINE
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1207Q00000XFamily Medicine Physician

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1184899916
Entity Type Code : Organization
Provider Name (Legal Business Name) : DALE FAMILY MEDICINE
Provider Business Mailing Address
First Line : 1340 S SAM HOUSTON BLVD
Second Line :
City : HOUSTON
State : MO
Zip : 65483-2045
Country : US
Telephone Number : 417-967-3755
Fax Number : 417-967-2630
Provider Business Practice Location Address
First Line : 1340 S SAM HOUSTON BLVD
Second Line :
City : HOUSTON
State : MO
Zip : 65483-2045
Country : US
Telephone Number : 417-967-3755
Fax Number : 417-967-2630
Authorized Official
Title or Position : DIRECTOR OF OPERATIONS
Name : MRS. AMY D LEDBETTER
Credential :
Telephone Number : 573-651-4488
Provider Enumeration Date : 04/23/2008
Last Update Date : 04/23/2008

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Directions to “DALE FAMILY MEDICINE ” Practice Location

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