Organization
MID MISSOURI MEDICAL CONSULTANTS, INC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
NANCY WADLEY (OFFICE MANAGER)
(573) 635-7651
Entity
Organization
Contact information
Practice address
1111 MADISON ST, JEFFERSON CITY, MO 65101-2753
(573) 635-7651
(573) 659-4515
Mailing address
1111 MADISON ST, JEFFERSON CITY, MO 65101-2753
(573) 635-7651
(573) 659-4515
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
R4N29
MO
2084N0400X
Neurology Physician
R8638
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
104047
BC/BS INSURANCE GROUP
MO
05
—
500166806
—
MO
Enumeration date
08/21/2006
Last updated
02/03/2010
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