Provider Demographics
NPI:1447342720
Name:SAMUEL K. TURNER D.O., P.C.
Entity type:Organization
Organization Name:SAMUEL K. TURNER D.O., P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT OF COMPANY
Authorized Official - Prefix:DR
Authorized Official - First Name:SAMUEL
Authorized Official - Middle Name:K
Authorized Official - Last Name:TURNER
Authorized Official - Suffix:JR
Authorized Official - Credentials:DO
Authorized Official - Phone:417-782-3032
Mailing Address - Street 1:702 E 34TH ST
Mailing Address - Street 2:SUITE 101
Mailing Address - City:JOPLIN
Mailing Address - State:MO
Mailing Address - Zip Code:64804-3967
Mailing Address - Country:US
Mailing Address - Phone:417-782-3032
Mailing Address - Fax:417-782-6466
Practice Address - Street 1:702 E 34TH ST
Practice Address - Street 2:SUITE 101
Practice Address - City:JOPLIN
Practice Address - State:MO
Practice Address - Zip Code:64804-3967
Practice Address - Country:US
Practice Address - Phone:417-782-3032
Practice Address - Fax:417-782-6466
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-28
Last Update Date:2013-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MOR5J96261QM2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM2500XAmbulatory Health Care FacilitiesClinic/CenterMedical Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
12848OtherBLUE SHIELD
MO242641702Medicaid
990001479Medicare PIN
MO242641702Medicaid