Organization
SPS PRACTICE GROUP, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. LESLIE SHOCK MD (OWNER)
(573) 224-8200
Entity
Organization
Contact information
Practice address
3220 BLUFF CREEK DR, COLUMBIA, MO 65201-3663
(573) 690-6129
Mailing address
3220 BLUFF CREEK DR STE 107, COLUMBIA, MO 65201-3664
(573) 224-8200
(573) 224-8026
Taxonomy
Speciality
Code
Description
License number
State
208200000X
Plastic Surgery Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1053046888
NPI
MO
Enumeration date
07/17/2022
Last updated
08/15/2023
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