1063696458 NPI number — CURATORS OF THE UNIVERSITY OF MISSOURI

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1063696458 NPI number — CURATORS OF THE UNIVERSITY OF MISSOURI

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CURATORS OF THE UNIVERSITY OF MISSOURI
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
UNIVERSITY PHYSICIANS SPECIALTY CARE ASSOCIEATES
Provider Other Organization Name Type Code:
3
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1063696458
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
12/21/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 7687
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
COLUMBIA
Provider Business Mailing Address State Name:
MO
Provider Business Mailing Address Postal Code:
65205-7687
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
573-882-2259
Provider Business Mailing Address Fax Number:
573-884-8526

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3302 W BROADWAY BUSINESS PARK CT
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
COLUMBIA
Provider Business Practice Location Address State Name:
MO
Provider Business Practice Location Address Postal Code:
65203-0169
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
573-882-6742
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
12/21/2007

Additional Information

Authorized Official

Authorized Official Last Name:
CRAWFORD
Authorized Official First Name:
JEFF
Authorized Official Middle Name:
H
Authorized Official Title or Position:
ASSISTAN ADMINISTRATOR FINANCE
Authorized Official Telephone Number:
573-882-7767

Provider Taxonomy Codes

  • Taxonomy code: 2085R0202X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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