# CORIZON HEALTH

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1528441276
- **Authorized official:** MR. RANDY BULLINGTON (MISSOURI REGIONAL PHYSICIAN RECRUIT)
- **Authorized official phone:** (573) 635-5315

## Contact information

- **Practice address:** 3702 W TRUMAN BLVD, SUITE 104, JEFFERSON CITY, MO 65109-4970
- **Practice address phone:** (573) 635-5315
- **Mailing address:** 36 STONEYSIDE LN, OLIVETTE, MO 63132-4122
- **Mailing address phone:** (314) 610-1839

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 261QP2400X | Prison Health Clinic/Center | 2015015777 | MO | Yes |

## Other

- **Enumeration date:** 06/30/2015
- **Last updated:** 06/30/2015