Individual
MRS. MARY ANN DIMARSICO
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
DO
Contact information
Practice address
1109 W CLAY RD, VERSAILLES, MO 65084-1177
(877) 733-5824
(888) 979-8868
Mailing address
821 WESTWOOD DR, SEDALIA, MO 65301-2102
(660) 826-4774
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
DOR2F10
MO
207Q00000X
Family Medicine Physician
Primary
R2F10
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
010053837
RR MEDICARE
—
01
—
16847
BLUE CROSS BLUE SHIELD
—
01
—
213038
HEALTHLINK
—
05
—
242215747
—
MO
01
—
876821
FIRST HEALTH
—
Enumeration date
02/23/2006
Last updated
05/26/2020
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