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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