Mary M. Dick, MD LLC

Primary specialty

Adult Mental Health Clinic/CenterTaxonomy code 261QM0850X

License

R8178 Issued in MO

Legal business name

MARY M. DICK, MD LLC

Practice address

2100 E Broadway
Suite 325
Columbia, MO 65201-6082

Phone

(573) 449-5800

Fax

(573) 693-4190

NPI assigned

Apr 10, 2012

Organization subpart

No

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

Authorized official

Name

Mary Margaret Dick, M.D.

Title

Owner

Phone

(573) 449-5800

Specialties & licenses 1

Addresses

Other identifiers 2

Other names 1

• Mary M. Dick, Inc Former legal business name

Locations

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

{
    "created_epoch": "1334016000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1334016000000",
    "number": "1396001723",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2100 E BROADWAY",
            "address_2": "SUITE 325",
            "city": "COLUMBIA",
            "state": "MO",
            "postal_code": "652016082",
            "telephone_number": "573-449-5800",
            "fax_number": "573-693-4190"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2100 E BROADWAY",
            "address_2": "SUITE 325",
            "city": "COLUMBIA",
            "state": "MO",
            "postal_code": "652016082",
            "telephone_number": "573-449-5800",
            "fax_number": "573-693-4190"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MARY M. DICK, MD LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2012-04-10",
        "last_updated": "2012-04-10",
        "status": "A",
        "authorized_official_last_name": "DICK",
        "authorized_official_first_name": "MARY",
        "authorized_official_middle_name": "MARGARET",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "573-449-5800",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "261QM0850X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Adult Mental Health",
            "state": "MO",
            "license": "R8178",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "COVENTRY HEALTH CARE PLAN",
            "identifier": "309074",
            "state": "MO"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "ANTHEM BLUE CROSS BLUE SHIELD",
            "identifier": "12382",
            "state": "MO"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Mary M. Dick, Inc",
            "code": "4",
            "type": "Former Legal Business Name"
        }
    ]
}

• Marty Enterprises, Inc
• Ahmed Marwan, M.D.
• Alexander Marx, DO
• Sean M Marx, MD
• Mary K Davis DDS LLC
• James Richard Marzolf, MD
• Casmir Cosmas Masega, AGACNP-AG
• Melissa Ann Liepins Masek, O.D.
• Michelle Marie Maskeri, MD
• Jessica Mason, PHARMD

• Adult Mental Health Clinic/Center in Columbia, MO
• Providers in Columbia, MO by specialty
• Adult Mental Health Clinic/Center in Missouri

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 10, 2012; 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.