Organization
VIENNA FAMILY PRACTICE LLC
Active
Other names
Vienna Family Practice Clinic
Organization subpart
No
Provider details
NPI number
Authorized official
KEITH EDWARD SEGALL D.O. (OWNER)
(573) 422-3360
Entity
Organization
Contact information
Practice address
111 PARKWAY, VIENNA, MO 65582-8003
(573) 422-3360
(573) 422-3391
Mailing address
111 PARKWAY, VIENNA, MO 65582-8003
(573) 422-3360
(573) 422-3391
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
D0106518
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
508242708
—
MO
Enumeration date
03/08/2007
Last updated
07/31/2008
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