Organization
MARINO PHILLIPS AND EARLY CLINIC LLC
Active
Other names
CROWN FAMILY MEDICINE LLC
Organization subpart
No
Provider details
NPI number
Authorized official
KIMBERLY D SWISHER (BUSINESS MANAGER)
(660) 665-2846
Entity
Organization
Contact information
Practice address
1 CROWN DR STE 200, KIRKSVILLE, MO 63501-2510
(660) 665-2846
Mailing address
1 CROWN DR STE 200, P O BOX R, KIRKSVILLE, MO 63501-2510
(660) 665-2846
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
—
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
113296
BLUE CROSS BLUE SHIELD
MO
05
—
503873408
—
MO
Enumeration date
05/01/2008
Last updated
07/20/2010
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