Organization
KIRKSVILLE ACADEMIC MEDICINE LLC
Active
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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