PREMISE HEALTH OF MISSOURI MEDICAL P C NPI 1396404299

NPI Information

NPI: 1396404299
Provider Name: PREMISE HEALTH OF MISSOURI MEDICAL P C

Doing Business As: BASS PRO SHOPS DBA OUTFITTERS HEALTH CENTER

Classification: Clinic/Center - 261QM1300X
Entity Type: Organization

Specialization: Multi-Specialty

Address:
2425 E KEARNEY ST
SPRINGFIELD, MO
ZIP 65803
Phone: (417) 612-8950
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PREMISE HEALTH OF MISSOURI MEDICAL P C is a multi-specialty clinic center in Springfield, MO. PREMISE HEALTH OF MISSOURI MEDICAL P C NPI is 1396404299. The provider is registered as an organization entity type.
The provider Is Doing Business As Bass Pro Shops Dba Outfitters Health Center.

The provider's business location address is:

2425 E KEARNEY ST
SPRINGFIELD, MO
ZIP 65803-969
Phone: (417) 612-8950
Fax: (417) 612-8955

The provider's authorized official is Jonathan Leizman .
The authorized official title is President and has the following contact phone number (216) 479-9063.

The CLIA number assigned to this NPI record is 26D2269563 - physician office with a certificate type of Certificate of Waiver.

The enumeration date for this NPI number is 12/8/2021 and was last updated on 10/13/2022.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No.	Taxonomy Code	Taxonomy Clasification	Taxonomy Specialization	License Number	License State	Primary
1	261QM1300X	Clinic/Center	Multi-Specialty			Yes

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 4/28/2024

NPI Synchronization or Removal

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