Organization
KIRKSVILLE ACADEMIC MEDICINE LLC
Active
Parent organization
KIRKSVILLE ACADEMIC MEDICINE LLC
Organization subpart
Yes
Provider details
NPI number
Legal business name
KIRKSVILLE ACADEMIC MEDICINE LLC
Authorized official
DEBBIE T BREWER (DIRECTOR OF PROVIDER ENROLLMENT)
(877) 892-9813
Entity
Organization
Contact information
Practice address
800 W JEFFERSON ST, KIRKSVILLE, MO 63501-1443
(660) 626-2235
(660) 626-2090
Mailing address
800 W JEFFERSON ST, KIRKSVILLE, MO 63501-1443
(660) 626-2235
(660) 626-2090
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
—
MO
207R00000X
Internal Medicine Physician
Primary
—
MO
207RC0000X
Cardiovascular Disease Physician
—
MO
208800000X
Urology Physician
—
—
363LF0000X
Family Nurse Practitioner
—
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0765826
—
IA
01
—
218276
ANTHEM BCBS
MO
05
—
504459702
—
MO
Enumeration date
03/08/2007
Last updated
10/21/2009
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