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Organization
CMMP SURGICAL CENTER LLC
Active
Organization
CMMP SURGICAL CENTER LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. CARL R DOERHOFF M.D. (MAJORITY PHYSICIAN OWNER)
(573) 659-5401
Entity
Organization
Contact information
Practice address
1705 CHRISTY DR, STE 100, JEFFERSON CITY, MO 65101-5195
(573) 635-7022
(573) 659-5443
Mailing address
1705 CHRISTY DR, STE 100, JEFFERSON CITY, MO 65101-5195
(573) 635-7022
(573) 659-5443
Taxonomy
Speciality
Code
Description
License number
State
261QA1903X
Ambulatory Surgical Clinic/Center
Primary
95-6
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
37
BCBS OF MO PROV NUMBER
MO
01
—
537147
HEALTHLINK PROV NUMBER
MO
01
—
6800140
UNITED HLTH CARE PROV NUM
MO
Enumeration date
06/01/2005
Last updated
04/20/2008
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