Mid-Missouri Internal Medicine Inc

Primary specialty

Internal Medicine PhysicianTaxonomy code 207R00000X

License

34425 Issued in MO

Legal business name

MID-MISSOURI INTERNAL MEDICINE INC

Practice address

1050 W 10TH St Ste 550
Rolla, MO 65401-2905

Phone

(573) 364-7545

Fax

(573) 368-3672

NPI assigned

Nov 30, 2005

Organization subpart

No

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

Authorized official

Name

Trish Leanne Klein

Title

Office Manager

Phone

(573) 364-7545

Specialties & licenses 1

Addresses

Other identifiers 5

Locations

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

{
    "created_epoch": "1133308800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1210550400000",
    "number": "1508840901",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1050 W 10TH ST STE 550",
            "city": "ROLLA",
            "state": "MO",
            "postal_code": "654012905",
            "telephone_number": "573-364-7545",
            "fax_number": "573-368-3672"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1050 W 10TH ST STE 550",
            "city": "ROLLA",
            "state": "MO",
            "postal_code": "654012905",
            "telephone_number": "573-364-7545",
            "fax_number": "573-368-3672"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MID-MISSOURI INTERNAL MEDICINE INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2005-11-30",
        "last_updated": "2008-05-12",
        "status": "A",
        "authorized_official_last_name": "KLEIN",
        "authorized_official_first_name": "TRISH",
        "authorized_official_middle_name": "LEANNE",
        "authorized_official_title_or_position": "OFFICE MANAGER",
        "authorized_official_telephone_number": "573-364-7545"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Internal Medicine",
            "state": "MO",
            "license": "34425",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "UNITED HEALTHCARE",
            "identifier": "1436867",
            "state": "MO"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE TRAVELERS",
            "identifier": "DG8365",
            "state": "MO"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS BLUE SHIELD",
            "identifier": "123495",
            "state": "MO"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PROVIDER NPI",
            "identifier": "1013100866",
            "state": "MO"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "504474602",
            "state": "MO"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• All providers in Rolla, MO
• Internal Medicine Physician in Missouri

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 12, 2008; 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.