Organization
MARY M. DICK, MD LLC
Active
Organization
MARY M. DICK, MD LLC
Active
Other names
Mary M. Dick, Inc
Organization subpart
No
Provider details
NPI number
Authorized official
MARY MARGARET DICK M.D. (OWNER)
(573) 449-5800
Entity
Organization
Contact information
Practice address
2100 E BROADWAY, SUITE 325, COLUMBIA, MO 65201-6082
(573) 449-5800
(573) 693-4190
Mailing address
2100 E BROADWAY, SUITE 325, COLUMBIA, MO 65201-6082
(573) 449-5800
(573) 693-4190
Taxonomy
Speciality
Code
Description
License number
State
261QM0850X
Adult Mental Health Clinic/Center
Primary
R8178
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
12382
ANTHEM BLUE CROSS BLUE SHIELD
MO
01
—
309074
COVENTRY HEALTH CARE PLAN
MO
Enumeration date
04/10/2012
Last updated
04/10/2012
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