MEDICARE: MOBERLY MEDICAL CLINICS INC

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
1	261QM1300X	Multi-Specialty Clinic/Center

Other Identifiers

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

General Provider Information

NPI Number	:	1336135607
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MOBERLY MEDICAL CLINICS INC

Provider Business Mailing Address
First Line	:	1515 UNION AVE
Second Line	:
City	:	MOBERLY
State	:	MO
Zip	:	65270-9407
Country	:	US
Telephone Number	:	660-269-3191
Fax Number	:	660-269-2943

Provider Business Practice Location Address
First Line	:	1513 UNION AVE
Second Line	:	SUITE 2300
City	:	MOBERLY
State	:	MO
Zip	:	65270-9407
Country	:	US
Telephone Number	:	660-263-8309
Fax Number	:	660-263-1948

Authorized Official
Title or Position	:	DIRECTOR OF PROVIDER ENROLLMENT
Name	:	DEBBIE BREWER
Credential	:
Telephone Number	:	615-465-7626

Provider Enumeration Date	:	09/22/2005
Last Update Date	:	09/13/2021

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Directions to “MOBERLY MEDICAL CLINICS INC ” Practice Location

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