MEDICARE: MRS. SHERI L STOFER PA-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	207RE0101X	Endocrinology, Diabetes & Metabolism Physician	2003004256	MO
2	363A00000X	Physician Assistant	2003004256	MO

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	MA2517	OTHER	MO	MEDICARE (GROUP)
4	26-8535	OTHER	MO	MEDICARE - RH

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	26D2006074	OTHER	MO	CLIA
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
5	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1568543155
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. SHERI L STOFER PA-C

Provider Business Mailing Address
First Line	:	1905 W 19TH ST
Second Line	:
City	:	MOUNTAIN GROVE
State	:	MO
Zip	:	65711-1287
Country	:	US
Telephone Number	:	417-926-1770
Fax Number	:	417-926-1785

Provider Business Practice Location Address
First Line	:	1905 W 19TH ST
Second Line	:
City	:	MOUNTAIN GROVE
State	:	MO
Zip	:	65711-1287
Country	:	US
Telephone Number	:	417-926-1770
Fax Number	:	417-926-1785

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/18/2006
Last Update Date	:	09/16/2010

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