1083133771 NPI number — MS. MARY JOAN KLEMP MED, RN, MSM, CCM

Table of content: MS. MARY JOAN KLEMP MED, RN, MSM, CCM (NPI 1083133771)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1083133771 NPI number — MS. MARY JOAN KLEMP MED, RN, MSM, CCM

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
KLEMP
Provider First Name:
MARY
Provider Middle Name:
JOAN
Provider Name Prefix Text:
MS.
Provider Name Suffix Text:
Provider Credential Text:
MED, RN, MSM, CCM
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
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:
1083133771
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
04/06/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
GENERAL LEONARD WOOD ARMY COMMUNITY HOSPITAL
Provider Second Line Business Mailing Address:
4430 MISSOURI AVE; MEDDAC CASE MANAGEMENT
Provider Business Mailing Address City Name:
FORT LEONARD WOOD
Provider Business Mailing Address State Name:
MO
Provider Business Mailing Address Postal Code:
65473
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
573-596-7715
Provider Business Mailing Address Fax Number:
573-596-9588

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
GANERAL LEONARD WOOD ARMY COMMUNITY HOSPITAL
Provider Second Line Business Practice Location Address:
4430 MISSOURI AVE; MEDDAC CASE MANAGEMENT; PRIMARY CARE
Provider Business Practice Location Address City Name:
FORT LEONARD WOOD
Provider Business Practice Location Address State Name:
MO
Provider Business Practice Location Address Postal Code:
65473
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
573-596-0540
Provider Business Practice Location Address Fax Number:
573-596-5342
Provider Enumeration Date:
09/13/2017

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 163WC0400X , with the licence number:  2005024694 , registered in the state of MO ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 207Q00000X , with the licence number: 2005024694 , registered in the state of MO ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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