Doctors Inn Clinic LLC

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

License

2000148413 Issued in MO

Legal business name

DOCTORS INN CLINIC LLC

Practice address

1112 South Byp Ste C
Suite C
Kennett, MO 63857-3738

Phone

(573) 717-1776

Fax

(573) 717-1572

NPI assigned

Jul 25, 2007

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Debbie A Wade, NPNPI 1174560965

Title

NP

Phone

(573) 717-1776

Specialties & licenses 1

Addresses

Other identifiers 4

Locations

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Debbie Ann Wade, FNP

  • Family Nurse Practitioner
  • Paragould, AR
  • NPI 1174560965
  NPD (past) Authorized official
• David Arthur Diffine, MD

  • Family Medicine Physician
  • Blytheville, AR
  • NPI 1679576631
  NPD

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1185321600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1267142400000",
    "number": "1114117306",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1112 SOUTH BYP",
            "address_2": "SUITE C",
            "city": "KENNETT",
            "state": "MO",
            "postal_code": "638573738",
            "telephone_number": "573-717-1776",
            "fax_number": "573-717-1572"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1112 SOUTH BYP STE C",
            "address_2": "SUITE C",
            "city": "KENNETT",
            "state": "MO",
            "postal_code": "638573738",
            "telephone_number": "573-717-1776",
            "fax_number": "573-717-1572"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "DOCTORS INN CLINIC LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-07-25",
        "last_updated": "2010-02-26",
        "status": "A",
        "authorized_official_last_name": "WADE",
        "authorized_official_first_name": "DEBBIE",
        "authorized_official_middle_name": "A",
        "authorized_official_title_or_position": "NP",
        "authorized_official_telephone_number": "573-717-1776",
        "authorized_official_credential": "NP"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Family Medicine",
            "state": "MO",
            "license": "2000148413",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "595409004",
            "state": "MO"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS MISSOURI",
            "identifier": "109494A-001",
            "state": "MO"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS ARKANSAS",
            "identifier": "SM707",
            "state": "MO"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "ARKANSAS MEDICAID",
            "identifier": "150606001",
            "state": "MO"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Bradley Deckard, P.T.
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• Sam L Dempey, M.A.
• Melanie Dickinson Gamble
• Doctors Health Group, Inc
• Gary Dennis Doherty Jr.
• Latisha Yvonne Donaldson
• Velma Louise Dority
• Julie A Dorris
• Crystal Doser

• Family Medicine Physician in Kennett, MO
• Providers in Kennett, MO by specialty
• Family Medicine Physician in Missouri

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 26, 2010; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.