Individual
JAMES R ENNIS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DO
Contact information
Practice address
180 NORTHSTAR, HOLTS SUMMIT, MO 65043
(573) 896-5115
(573) 896-4272
Mailing address
180 NORTHSTAR, CAPITAL REGION MEDICAL CLINIC, HOLTS SUMMIT, MO 65043
(573) 896-5115
(573) 896-4272
Taxonomy
Speciality
Code
Description
License number
State
208D00000X
General Practice Physician
Primary
R6639
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
100491
BLUE CROSS BLUE SHIELD
—
01
—
104257
HEALTHLINK
—
05
—
240009803
—
MO
05
—
501607808
—
MO
01
—
7779636
CIGNA
—
01
—
813149
FIRST HEALTH
—
Enumeration date
02/03/2006
Last updated
07/19/2012
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