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Organization

BOLIVAR OB/GYN

Active
Parent organization
SIGNATURE MEDICAL GROUP
Other names
Bolivar OB/GYN
Organization subpart
Yes

Provider details

NPI number
Legal business name
SIGNATURE MEDICAL GROUP
Authorized official
MRS. DEBRA R VOLCKO MT(ASCP) CSC, COBGC (BUSINESS MANAGER)
(417) 777-8131
Entity
Organization

Contact information

Practice address
1165 N BUTTERFIELD RD, SUITE B, BOLIVAR, MO 65613-1056
(417) 777-8131
(417) 777-8892
Mailing address
1165 N BUTTERFIELD RD, SUITE B, BOLIVAR, MO 65613-1056
(417) 777-8131
(417) 777-8892

Taxonomy

Speciality
Code
Description
License number
State
207V00000X
Obstetrics & Gynecology Physician
Primary
2013021740
MO

Other

Enumeration date
02/05/2014
Last updated
02/05/2014
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