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Organization
CORIZON HEALTH
Active
Organization
CORIZON HEALTH
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. RANDY BULLINGTON (MISSOURI REGIONAL PHYSICIAN RECRUIT)
(573) 635-5315
Entity
Organization
Contact information
Practice address
3702 W TRUMAN BLVD, SUITE 104, JEFFERSON CITY, MO 65109-4970
(573) 635-5315
Mailing address
36 STONEYSIDE LN, OLIVETTE, MO 63132-4122
(314) 610-1839
Taxonomy
Speciality
Code
Description
License number
State
261QP2400X
Prison Health Clinic/Center
Primary
2015015777
MO
Other
Enumeration date
06/30/2015
Last updated
06/30/2015
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