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Organization
MID-MISSOURI NEONATOLOGY LLC
Active
Organization
MID-MISSOURI NEONATOLOGY LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MS. BRENDA LEE WILSON (INSURANCE AND BILLING SPECIALIST)
(573) 815-9700
Entity
Organization
Contact information
Practice address
1600 E BROADWAY, COLUMBIA, MO 65201-5844
(573) 815-3737
(573) 815-3716
Mailing address
PO BOX 10200, COLUMBIA, MO 65205-4003
(573) 815-9700
(573) 815-0700
Taxonomy
Speciality
Code
Description
License number
State
2080N0001X
Neonatal-Perinatal Medicine Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
129002
ANTHEM BCBS GROUP PIN
MO
01
—
19413
HEALTH CARE USA GROUP PIN
—
01
—
26831
GHP GROUP PIN
—
Enumeration date
11/09/2006
Last updated
08/22/2020
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