Provider Demographics
NPI:1174572770
Name:NORTHEAST MISSOURI PHYSICIANS SERVICES
Entity type:Organization
Organization Name:NORTHEAST MISSOURI PHYSICIANS SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE VICE PRESIDENT, EPP
Authorized Official - Prefix:
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:L
Authorized Official - Last Name:MURPHY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:800-444-7009
Mailing Address - Street 1:PO BOX 41878
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19101-1878
Mailing Address - Country:US
Mailing Address - Phone:800-444-7009
Mailing Address - Fax:
Practice Address - Street 1:315 S OSTEOPATHY
Practice Address - Street 2:
Practice Address - City:KIRKSVILLE
Practice Address - State:MO
Practice Address - Zip Code:63501-6401
Practice Address - Country:US
Practice Address - Phone:660-785-1000
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-09
Last Update Date:2008-04-20
Deactivation Date:2006-05-11
Deactivation Code:
Reactivation Date:2006-06-08
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO183342OtherBLUE SHIELD
MO=========OtherTRICARE