Organization
SEDALIA INTERNAL MEDICINE SPECIALISTS PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
TONI R WARREN (OFFICE MANAGER)
(660) 827-2526
Entity
Organization
Contact information
Practice address
1712 S LAFAYETTE AVE, SEDALIA, MO 65301-7542
(660) 827-2526
(660) 827-5536
Mailing address
1712 S LAFAYETTE AVE, SEDALIA, MO 65301-7542
(660) 827-2526
(660) 827-5536
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
09962017
BLUE SHIELD PROVIDER NUMB
MO
05
—
501695605
—
MO
Enumeration date
03/07/2007
Last updated
07/16/2015
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