Organization
MID-MISSOURI INTERNAL MEDICINE INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
TRISH LEANNE KLEIN (OFFICE MANAGER)
(573) 364-7545
Entity
Organization
Contact information
Practice address
1050 W 10TH ST STE 550, ROLLA, MO 65401-2905
(573) 364-7545
(573) 368-3672
Mailing address
1050 W 10TH ST STE 550, ROLLA, MO 65401-2905
(573) 364-7545
(573) 368-3672
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
34425
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1013100866
PROVIDER NPI
MO
01
—
123495
BLUE CROSS BLUE SHIELD
MO
01
—
1436867
UNITED HEALTHCARE
MO
05
—
504474602
—
MO
01
—
DG8365
MEDICARE TRAVELERS
MO
Enumeration date
11/30/2005
Last updated
05/12/2008
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