# MISSOURI STATE UNIVERSITY

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- **Entity:** Organization
- **Status:** Active
- **Other names:** The Kitchen Clinic
- **Organization subpart:** No

## Provider details

- **NPI number:** 1477893907
- **Authorized official:** MARK BOWER M.D. (PHYSICIAN, MEDICAL DIRECTOR)
- **Authorized official phone:** (417) 837-1500

## Contact information

- **Practice address:** 1630 N JEFFERSON AVE, SPRINGFIELD, MO 65803-2819
- **Practice address phone:** (417) 837-1504
- **Practice address fax:** (417) 837-1545
- **Mailing address:** MISSOURI STATE DEPARTMENT OF NURSING, 901 S. NATIONAL AVENUE, SPRINGFIELD, MO 65897-0001
- **Mailing address phone:** (417) 836-5310
- **Mailing address fax:** (417) 836-5484

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 261QC1500X | Community Health Clinic/Center | 2013003462 | MO | Yes |

## Other

- **Enumeration date:** 02/20/2013
- **Last updated:** 02/20/2013