Bolivar OB/GYN – Obstetrics & Gynecology Physician

Key facts

NPI: 1720402175
Entity type: Organization (NPI type 2)
Primary specialty: Obstetrics & Gynecology Physician 207V00000X
License: 2013021740 (MO)
Legal business name: BOLIVAR OB/GYN
Practice address: 1165 N Butterfield Rd
Suite B
Bolivar, MO 65613-1056
Phone: (417) 777-8131
Fax: (417) 777-8892
NPI assigned: Feb 5, 2014
Organization subpart: Yes
Parent organization (as reported): SIGNATURE MEDICAL GROUP

Authorized official

Name: Mrs. Debra R Volcko, MT(ASCP) CSC, COBGC
Title: Business Manager
Phone: (417) 777-8131

Practitioners 1

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

Sarah B Kallberg, D.O. Obstetrics & Gynecology Physician · Bolivar, MO · NPI 1285860551

NPD (past) OBSTETRICS & GYNECOLOGY

National Provider Directory

Locations

1165 N Butterfield Rd
Ste B
Bolivar, MO 65613
Phone (417) 777-8131

12855 N 40 Dr
Ste 180L
Saint Louis, MO 63141

Specialties & licenses

Specialty (taxonomy)	Code	License	State	Primary
Obstetrics & Gynecology Physician Group: 193400000X SINGLE SPECIALTY GROUP	207V00000X	2013021740	MO	Yes

Addresses

Primary practice location

1165 N Butterfield Rd
Suite B
Bolivar, MO 65613-1056

Mailing address

1165 N Butterfield Rd
Suite B
Bolivar, MO 65613-1056
Phone (417) 777-8131

Other names

Bolivar OB/GYN Doing business as

Other providers in Bolivar, MO

All providers in Bolivar, MO · Obstetrics & Gynecology 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 Feb 5, 2014. Information in NPPES is self-reported and not verified by CMS.
NUCC Health Care Provider Taxonomy: specialty names.
National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.