Moberly Medical Clinics Inc

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

Legal business name

MOBERLY MEDICAL CLINICS INC

Practice address

136 Shelby Plaza Rd
Shelbina, MO 63468-1065

Phone

(573) 588-1111

Fax

(573) 588-1114

NPI assigned

May 23, 2007

Organization subpart

No

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

Authorized official

Name

Debbie Brewer

Title

Director of Provider Enrollment

Phone

(615) 465-7626

Specialties & licenses 6

Addresses

Tax ID family

Moberly Diagnostics2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

Organizations that report the same tax identification number in the National Provider Directory.

• Moberly Medical Clinics Inc

  dba Moberly Diagnostics

  • Radiology Clinic/Center
  • Moberly, MO
  • NPI 1003226010
  NPD tax ID

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

{
    "created_epoch": "1179878400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1658361600000",
    "number": "1124238555",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "136 SHELBY PLAZA RD",
            "city": "SHELBINA",
            "state": "MO",
            "postal_code": "634681065",
            "telephone_number": "573-588-1111",
            "fax_number": "573-588-1114"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "136 SHELBY PLAZA RD",
            "city": "SHELBINA",
            "state": "MO",
            "postal_code": "634681065",
            "telephone_number": "573-588-1111",
            "fax_number": "573-588-1114"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MOBERLY MEDICAL CLINICS INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-05-23",
        "last_updated": "2022-07-21",
        "status": "A",
        "authorized_official_last_name": "BREWER",
        "authorized_official_first_name": "DEBBIE",
        "authorized_official_title_or_position": "DIRECTOR OF PROVIDER ENROLLMENT",
        "authorized_official_telephone_number": "615-465-7626"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Family Medicine",
            "state": "MO",
            "license": null,
            "primary": true
        },
        {
            "code": "207R00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Internal Medicine",
            "state": "MO",
            "license": null,
            "primary": false
        },
        {
            "code": "207RP1001X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Internal Medicine, Pulmonary Disease",
            "state": "MO",
            "license": null,
            "primary": false
        },
        {
            "code": "208000000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Pediatrics",
            "state": "MO",
            "license": null,
            "primary": false
        },
        {
            "code": "363A00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Physician Assistant",
            "state": "MO",
            "license": null,
            "primary": false
        },
        {
            "code": "363LF0000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Nurse Practitioner, Family",
            "state": "MO",
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Hannibal Regional Health Care System
• Hannibal Regional Healthcare System, Inc (Shelbina Family Practice)
• Adrienne Harvey, SLP-A
• Johnston Drug - Shelbina
• Lou Ann McEwen
• Wendell Allan Nickerson, D.O.
• David F. Ouellette, M.D.
• Barbara B Russell, DDS
• Wesley A Russell II, DDS
• Kelly M Sadler, PT, DPT

• Family Medicine Physician in Shelbina, MO
• Providers in Shelbina, 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 Jul 21, 2022; 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.