Organization
DEXTER HOSPITAL LLC
Active
Other names
MSH INTERNAL MEDICINE OF BLOOMFIELD
Organization subpart
No
Provider details
NPI number
Authorized official
SUE ANN WILLIAMS (CLINIC ADMINISTRATOR)
(573) 624-1640
Entity
Organization
Contact information
Practice address
1003 HIGHWAY 25 NORTH, BLOOMFIELD, MO 63825
(573) 568-3686
Mailing address
PO BOX 368, DEXTER, MO 63841
(573) 624-3165
(573) 624-3157
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
—
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
DC5318
RAILROAD MEDICARE
MO
Enumeration date
12/11/2006
Last updated
04/09/2008
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