Organization
STATE OF MISSOURI
Active
Parent organization
STATE OF MISSOURI
Other names
NWCS-Howerton Integrated Medical Clinic
Organization subpart
Yes
Provider details
NPI number
Legal business name
STATE OF MISSOURI
Authorized official
MOLLY JANE BOECKMANN (DIRECTOR OF ADMINISTRATIVE SERVICES)
(573) 751-4055
Entity
Organization
Contact information
Practice address
1547 W. COMMERCE DR, MARSHALL, MO 65340-1240
(660) 886-2201
(660) 831-3071
Mailing address
1706 E ELM ST, JEFFERSON CITY, MO 65101-4130
(573) 751-3398
(573) 526-4560
Taxonomy
Speciality
Code
Description
License number
State
208D00000X
General Practice Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
501499800
—
MO
Enumeration date
05/20/2006
Last updated
08/31/2020
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