NPIMap

Organization Active NPI

Healthstat on-Site Clinic Watlow Hannibal Mo

  • Preventive Medicine/Occupational Environmental Medicine Physician
  • Hannibal, MO
National Provider Identifier
1720486756
Registry record updated Dec 8, 2014
On this page

Key facts

NPPES NPI Registry
Primary specialty
Preventive Medicine/Occupational Environmental Medicine PhysicianTaxonomy code 2083P0500X
Legal business name
HEALTHSTAT ON-SITE CLINIC WATLOW HANNIBAL MO
Practice address
6 Industrial Loop
Hannibal, MO 63401-6052
Phone
(704) 529-6161
NPI assigned
Dec 8, 2014
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Dec 8, 2014

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

Authorized official

Name
Warren Hutton
Title
Coo
Phone
(704) 529-6161

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Preventive Medicine/Occupational Environmental Medicine PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 2083P0500X Primary

Addresses

Primary practice location

6 Industrial Loop
Hannibal, MO 63401-6052

Mailing address

4651 Charlotte Park Dr
Suite 300
Charlotte, NC 28217-1956

National Provider Directory

National Provider Directory
Tax ID family
Healthstat on-Site Clinic Watlow Hannibal Mo9 organizations share this tax ID, including this one

Other organizations with this tax ID 8

Organizations that report the same tax identification number in the National Provider Directory.

Locations

6 Industrial Loop
Hannibal, MO 63401

NPI Registry JSON

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

{
    "created_epoch": "1417996800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1417996800000",
    "number": "1720486756",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4651 CHARLOTTE PARK DR",
            "address_2": "SUITE 300",
            "city": "CHARLOTTE",
            "state": "NC",
            "postal_code": "282171956"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6 INDUSTRIAL LOOP",
            "city": "HANNIBAL",
            "state": "MO",
            "postal_code": "634016052",
            "telephone_number": "704-529-6161"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "HEALTHSTAT ON-SITE CLINIC WATLOW HANNIBAL MO",
        "organizational_subpart": "NO",
        "enumeration_date": "2014-12-08",
        "last_updated": "2014-12-08",
        "status": "A",
        "authorized_official_last_name": "HUTTON",
        "authorized_official_first_name": "WARREN",
        "authorized_official_title_or_position": "COO",
        "authorized_official_telephone_number": "704-529-6161"
    },
    "taxonomies": [
        {
            "code": "2083P0500X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Preventive Medicine, Preventive Medicine/Occupational Environmental Medicine",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Hannibal, MO

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 8, 2014; 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.