Active NPI
Ziva Medical Audrain LLC
- Multi-Specialty Clinic/Center
- Mexico, MO
National Provider Identifier
1609655323
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Multi-Specialty Clinic/Center
- Legal business name
- ZIVA MEDICAL AUDRAIN LLC
- Practice address
- 515 E Promenade St # a
Mexico, MO 65265-2966 - Phone
- (573) 570-3520
- Fax
- (573) 675-6040
- NPI assigned
- Sep 22, 2023
- Organization subpart
- Yes
- Parent organization
- ZIVA MEDICAL AUDRAIN LLC
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Authorized official
- Name
- Amanda Shurtz
- Title
- Ceo
- Phone
- (573) 570-3555
Specialties & licenses 5
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Multi-Specialty Clinic/Center | 261QM1300X | Primary | ||
| Physician Assistant | 363A00000X | |||
| Nurse Practitioner | 363L00000X | |||
| Family Nurse Practitioner | 363LF0000X | |||
| Primary Care Nurse Practitioner | 363LP2300X |
Addresses
Primary practice location
515 E Promenade St # a
Mexico, MO 65265-2966
Mailing address
PO Box 197
Lakewood, NJ 08701-0197
Other names 1
- ZIVAMED PRIMARY CARE
National Provider Directory
National Provider Directory- Part of
- Ziva Medical Audrain LLC
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1695340800000",
"enumeration_type": "NPI-2",
"last_updated_epoch": "1701302400000",
"number": "1609655323",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 197",
"city": "LAKEWOOD",
"state": "NJ",
"postal_code": "087010197"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "515 E PROMENADE ST # A",
"city": "MEXICO",
"state": "MO",
"postal_code": "652652966",
"telephone_number": "573-570-3520",
"fax_number": "573-675-6040"
}
],
"practiceLocations": [],
"basic": {
"organization_name": "ZIVA MEDICAL AUDRAIN LLC",
"organizational_subpart": "YES",
"parent_organization_legal_business_name": "ZIVA MEDICAL AUDRAIN LLC",
"enumeration_date": "2023-09-22",
"last_updated": "2023-11-30",
"certification_date": "2023-11-30",
"status": "A",
"authorized_official_last_name": "SHURTZ",
"authorized_official_first_name": "AMANDA",
"authorized_official_title_or_position": "CEO",
"authorized_official_telephone_number": "573-570-3555"
},
"taxonomies": [
{
"code": "261QM1300X",
"taxonomy_group": "",
"desc": "Clinic/Center, Multi-Specialty",
"state": null,
"license": null,
"primary": true
},
{
"code": "363A00000X",
"taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
"desc": "Physician Assistant",
"state": null,
"license": null,
"primary": false
},
{
"code": "363L00000X",
"taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
"desc": "Nurse Practitioner",
"state": null,
"license": null,
"primary": false
},
{
"code": "363LF0000X",
"taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
"desc": "Nurse Practitioner, Family",
"state": null,
"license": null,
"primary": false
},
{
"code": "363LP2300X",
"taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
"desc": "Nurse Practitioner, Primary Care",
"state": null,
"license": null,
"primary": false
}
],
"identifiers": [],
"endpoints": [],
"other_names": [
{
"organization_name": "ZIVAMED PRIMARY CARE",
"code": "3",
"type": "Doing Business As"
}
]
}Other providers in Mexico, MO
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 30, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.