Organization
COLLEGE SKYLINE CENTER LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. TRACY EDDINGTON (ADMINISTRATION)
(417) 782-1443
Entity
Organization
Contact information
Practice address
1230 N DUQUESNE RD, JOPLIN, MO 64801-1509
(417) 782-1443
(417) 782-3240
Mailing address
1230 N DUQUESNE RD, JOPLIN, MO 64801-1509
(417) 782-1443
(417) 782-3240
Taxonomy
Speciality
Code
Description
License number
State
261Q00000X
Clinic/Center
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
507593408
—
MO
Enumeration date
07/15/2005
Last updated
05/04/2017
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