Organization
CENTRAL MISSOURI SURGERY LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
KIMBERLY C SUPPES M.D. (SOLE MEMBER)
(573) 876-1630
Entity
Organization
Contact information
Practice address
401 KEENE ST, THE BOONE CLINIC BUILDING, COLUMBIA, MO 65201-6625
(573) 876-1630
(576) 876-1665
Mailing address
401 KEENE ST, THE BOONE CLINIC BUILDING, COLUMBIA, MO 65201-6625
(573) 876-1630
(576) 876-1665
Taxonomy
Speciality
Code
Description
License number
State
208600000X
Surgery Physician
Primary
2001018694
MO
Other
Enumeration date
04/29/2010
Last updated
07/29/2010
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