# BOLIVAR OB/GYN

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- **Entity:** Organization
- **Status:** Active
- **Parent organization:** SIGNATURE MEDICAL GROUP
- **Other names:** Bolivar OB/GYN
- **Organization subpart:** Yes

## Provider details

- **NPI number:** 1720402175
- **Legal business name:** SIGNATURE MEDICAL GROUP
- **Authorized official:** MRS. DEBRA R VOLCKO MT(ASCP) CSC, COBGC (BUSINESS MANAGER)
- **Authorized official phone:** (417) 777-8131

## Contact information

- **Practice address:** 1165 N BUTTERFIELD RD, SUITE B, BOLIVAR, MO 65613-1056
- **Practice address phone:** (417) 777-8131
- **Practice address fax:** (417) 777-8892
- **Mailing address:** 1165 N BUTTERFIELD RD, SUITE B, BOLIVAR, MO 65613-1056
- **Mailing address phone:** (417) 777-8131
- **Mailing address fax:** (417) 777-8892

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207V00000X | Obstetrics & Gynecology Physician | 2013021740 | MO | Yes |

## Other

- **Enumeration date:** 02/05/2014
- **Last updated:** 02/05/2014