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LEVEL 4 MEDICAL PROFESSIONAL CORPORATION NPI 1861706434


NPI Information

NPI: 1861706434
Provider Name: LEVEL 4 MEDICAL PROFESSIONAL CORPORATION

Doing Business As: STOCKTON LAKE WALKIN CLINIC

Classification: Point of Service - 305S00000X
Entity Type: Organization

CLIA Number: 26D2009433

Address:
913 SOUTH ST
STOCKTON, MO
ZIP 65785
Phone: (417) 809-8620
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LEVEL 4 MEDICAL PROFESSIONAL CORPORATION is a point of service in Stockton, MO. The provider is this product may also be called an open-ended HMO and offers a transition product incorporating features of both HMOs and PPOs. Beneficiaries are enrolled in an HMO but have the option to go outside the networks for an additional cost. LEVEL 4 MEDICAL PROFESSIONAL CORPORATION NPI is 1861706434. The provider is registered as an organization entity type.
The provider Is Doing Business As Stockton Lake Walkin Clinic.

The provider's business location address is:

913 SOUTH ST
STOCKTON, MO
ZIP 65785-381
Phone: (417) 809-8620

The provider's authorized official is David E Smock .
The authorized official title is Owner and has the following contact phone number (928) 503-4261.

The CLIA number assigned to this NPI record is 26D2009433 - physician office with a certificate type of Certificate of Waiver.

The enumeration date for this NPI number is 8/5/2010 and was last updated on 1/29/2015.


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 CodeTaxonomy ClasificationTaxonomy SpecializationLicense NumberLicense StatePrimary
1305S00000XPoint of Service2003017056MISSOURIYes

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

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