Advanced Senior Care of Missouri Inc
Organization Active NPI Internal Medicine Physician · Columbia, MO
NPI 1245087295 · NPPES record last updated Nov 12, 2024
Key facts
- NPI
- 1245087295
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Internal Medicine Physician 207R00000X
- Legal business name
- ADVANCED SENIOR CARE OF MISSOURI INC
- Practice address
- 910 N College Ave Ste 4
Columbia, MO 65201-4797 - Phone
- (636) 642-1215
- Fax
- (573) 234-4799
- NPI assigned
- May 6, 2024
- Organization subpart
- No
Authorized official
- Name
- Bradley Beaird
- Title
- Owner
- Phone
- (636) 642-1215
Practitioners 12
-
Penny Fulks, MSN, APRN, NP-C
-
Cheryl Lynn Kyle, APRN FNP-BC
-
Melissa Anne Pickett, ACNS-BC
-
Beth Ann Sjoblom, MD
-
Ruanne M Stamps, MD
-
Shahbaz A. Riaz, MD
-
Erma Ruth Johnmeyer, FNP-C
-
Miranda Fitzpatrick, FNP
-
Randi Elizabeth Luper, MSN, APRN, FNP-C
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in MO
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20240613000443 | MO | Part B Supplier - Clinic/Group Practice | 1052853421 |
Receives reassigned benefits from 10 practitioners Practice locations: Columbia, MO; Mexico, MO; Eldon, MO; Fulton, MO; Glasgow, MO; Holts Summit, MO; Jefferson City, MO; Marshall, MO… |
National Provider Directory
Locations
910 N College Ave
Columbia, MO 65201
2910 Bluff Creek Dr
Columbia, MO 65201
Phone (573) 256-4620
700 N Garth Ave
Columbia, MO 65203
Phone (573) 443-2556
1325 S Highland Ct
Marshall, MO 65340
Phone (636) 358-1889
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Family Medicine Physician |
207Q00000X | |||
| Internal Medicine Physician |
207R00000X | Yes |
Addresses
Primary practice location
910 N College Ave Ste 4
Columbia, MO 65201-4797
Mailing address
910 N College Ave Ste 4
Columbia, MO 65201-4797
Phone (636) 642-1215
Other names
- Advanced Senior Care
Other providers in Columbia, MO
- Florence Ifeoma Adimora-Nweke
- Charlene Adkins
- Cary Dean Adkisson
- Advanced Medical Group, LLC
- Advanced Physical Health, P.C.
- Advanced Senior Care, Inc
- Advanced Sleep Labs, L.L.C.
- Advanced Vision, LLC
- Aerocare Home Medical Equipment, Inc
- Aeromind Services
All providers in Columbia, MO · Internal Medicine Physician in Missouri
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Nov 12, 2024. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.