MEDICARE: HANNIBAL CLINIC OPERATIONS, L.L.C.

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	207R00000X	Internal Medicine Physician

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	000013771	OTHER	MO	PTAN

General Provider Information

NPI Number	:	1447239157
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	HANNIBAL CLINIC OPERATIONS, L.L.C.

Provider Business Mailing Address
First Line	:	100 MEDICAL DR
Second Line	:
City	:	HANNIBAL
State	:	MO
Zip	:	63401-6877
Country	:	US
Telephone Number	:	573-221-5250
Fax Number	:	573-231-3824

Provider Business Practice Location Address
First Line	:	400 N MAIN ST
Second Line	:
City	:	MONROE CITY
State	:	MO
Zip	:	63456-1318
Country	:	US
Telephone Number	:	573-735-4541
Fax Number	:	573-735-2143

Authorized Official
Title or Position	:	PHYSICIAN EXEC DIRECTOR
Name	:	MR. MICHAEL J BUKSTEIN
Credential	:	MD
Telephone Number	:	573-231-3172

Provider Enumeration Date	:	01/11/2006
Last Update Date	:	04/18/2022

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Directions to “HANNIBAL CLINIC OPERATIONS, L.L.C. ” Practice Location

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