MEDICARE: EPOCH - CENTRAL MISSOURI LIMITED LIABILITY COMPANY

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	208D00000X	General Practice Physician

General Provider Information

NPI Number	:	1710383435
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	EPOCH - CENTRAL MISSOURI LIMITED LIABILITY COMPANY

Provider Business Mailing Address
First Line	:	2900 TRIMBLE RD.
Second Line	:
City	:	COLUMBIA
State	:	MO
Zip	:	65201-6465
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	2900 TRIMBLE RD.
Second Line	:
City	:	COLUMBIA
State	:	MO
Zip	:	65201-6465
Country	:	US
Telephone Number	:	573-818-3067
Fax Number	:

Authorized Official
Title or Position	:	AUTHORIZED OFFICIAL
Name	:	STEVE HOUSE
Credential	:
Telephone Number	:	817-239-9801

Provider Enumeration Date	:	11/06/2014
Last Update Date	:	09/29/2015

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