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NPI Code Detail

MEDICARE: ACADEMIC MEDICINE

MEDICARE: ACADEMIC 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
1174400000XSpecialist
2207RC0000XCardiovascular Disease PhysicianMO

General Provider Information

NPI Number : 1255331211
Entity Type Code : Organization
Provider Name (Legal Business Name) : ACADEMIC MEDICINE
Provider Business Mailing Address
First Line : 800 W JEFFERSON ST
Second Line :
City : KIRKSVILLE
State : MO
Zip : 63501-1443
Country : US
Telephone Number : 660-626-2235
Fax Number : 660-626-2090
Provider Business Practice Location Address
First Line : 800 W JEFFERSON ST
Second Line :
City : KIRKSVILLE
State : MO
Zip : 63501-1443
Country : US
Telephone Number : 660-626-2235
Fax Number : 660-626-2090
Authorized Official
Title or Position : PRESIDENT
Name : DR. SCOTT ANDERSON
Credential : D.O.
Telephone Number : 660-626-2235
Provider Enumeration Date : 07/29/2005
Last Update Date : 07/21/2022

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Directions to “ACADEMIC MEDICINE ” Practice Location

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