Organization
CHERRY HILL CLINIC, LLC
Active
Other names
Cherry Hill Clinic
Organization subpart
No
Provider details
NPI number
Authorized official
ELLEN DUKATE (CREDENTIALING SPECIALIST)
(904) 515-2625
Entity
Organization
Contact information
Practice address
1160 E HIGH POINT LN, COLUMBIA, MO 65203-9335
(352) 226-7603
Mailing address
1160 E HIGH POINT LN, COLUMBIA, MO 65203-9335
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2011003501
MD LICENSE
MO
Enumeration date
09/20/2017
Last updated
09/20/2017
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