Organization
KENNETH A DECOURSEY, MD PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
KENNETH A DECOURSEY M.D. (PRESIDENT)
(573) 334-7194
Entity
Organization
Contact information
Practice address
1723 BROADWAY ST, SUITE 120, CAPE GIRARDEAU, MO 63701-4505
(573) 334-7194
(573) 334-4937
Mailing address
5311 LEXINGTON ST, JACKSON, MO 63755-3825
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0106771
UNITED HEALTHCARE
—
01
—
131268
BLUE CROSS/BLUE SHIELD
MO
01
—
180360
BLUE CROSS/BLUE SHIELD
MO
01
—
649138
HEALTHLINK
—
Enumeration date
05/05/2006
Last updated
08/22/2020
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