Organization
RENOVA MEDICAL CENTER, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
KERRIE J ROSE MBA (OWNER)
(573) 228-0217
Entity
Organization
Contact information
Practice address
1401 FORUM BLVD STE 101, COLUMBIA, MO 65203-1915
(573) 228-0217
(573) 234-1368
Mailing address
1401 FORUM BLVD STE 101, COLUMBIA, MO 65203-1915
(573) 228-0217
(573) 234-1368
Taxonomy
Speciality
Code
Description
License number
State
208D00000X
General Practice Physician
Primary
—
—
Other
Enumeration date
05/23/2018
Last updated
05/23/2018
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