Provider Demographics
NPI:1881715720
Name:MISSOURI VALLEY PHYSICIANS PC
Entity type:Organization
Organization Name:MISSOURI VALLEY PHYSICIANS PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JACK
Authorized Official - Middle Name:R
Authorized Official - Last Name:UHRIG
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:660-886-3364
Mailing Address - Street 1:2303 S HIGHWAY 65
Mailing Address - Street 2:
Mailing Address - City:MARSHALL
Mailing Address - State:MO
Mailing Address - Zip Code:65340-3702
Mailing Address - Country:US
Mailing Address - Phone:660-886-3364
Mailing Address - Fax:660-886-6044
Practice Address - Street 1:307 MAIN ST
Practice Address - Street 2:
Practice Address - City:SLATER
Practice Address - State:MO
Practice Address - Zip Code:65349-1413
Practice Address - Country:US
Practice Address - Phone:660-529-2251
Practice Address - Fax:660-529-9763
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-02
Last Update Date:2008-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO501133516Medicaid
MO2770000Medicare ID - Type UnspecifiedPROVIDERS NUMBER