NPIMap

Organization Active NPI

Ebo MD LLC

  • Family Medicine Physician
  • Cape Girardeau, MO
National Provider Identifier
1326503376
Registry record updated Feb 4, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
Legal business name
EBO MD LLC
Practice address
1417 N Mount Auburn Rd Ste a
Cape Girardeau, MO 63701-2171
Phone
(573) 803-2941
Fax
(573) 803-0815
NPI assigned
Feb 4, 2019
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Feb 4, 2019

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

Authorized official

Name
Genni L Ourth
Title
Manager
Phone
(573) 803-2941

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 207Q00000X Primary

Addresses

Primary practice location

1417 N Mount Auburn Rd Ste a
Cape Girardeau, MO 63701-2171

Mailing address

1417 N Mount Auburn Rd Ste a
Cape Girardeau, MO 63701-2171
Phone (573) 803-2941

National Provider Directory

National Provider Directory

Locations

1417 N Mount Auburn Rd
Ste A
Cape Girardeau, MO 63701
Phone (573) 803-2941

Practitioners & affiliated clinicians

Practitioners 4

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

NPI Registry JSON

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

{
    "created_epoch": "1549238400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1549238400000",
    "number": "1326503376",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1417 N MOUNT AUBURN RD STE A",
            "city": "CAPE GIRARDEAU",
            "state": "MO",
            "postal_code": "637012171",
            "telephone_number": "573-803-2941",
            "fax_number": "573-803-0815"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1417 N MOUNT AUBURN RD STE A",
            "city": "CAPE GIRARDEAU",
            "state": "MO",
            "postal_code": "637012171",
            "telephone_number": "573-803-2941",
            "fax_number": "573-803-0815"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "EBO MD LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2019-02-04",
        "last_updated": "2019-02-04",
        "status": "A",
        "authorized_official_last_name": "OURTH",
        "authorized_official_first_name": "GENNI",
        "authorized_official_middle_name": "L",
        "authorized_official_title_or_position": "MANAGER",
        "authorized_official_telephone_number": "573-803-2941"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Family Medicine",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Cape Girardeau, MO

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 4, 2019; 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.