Southern Missouri Internal Medicine, PC

Primary specialty

Internal Medicine PhysicianTaxonomy code 207R00000X

License

DO100129 Issued in MO

Legal business name

SOUTHERN MISSOURI INTERNAL MEDICINE, PC

Practice address

3260 Lexington Ave
Cape Girardeau, MO 63701-2609

Phone

(573) 335-5057

Fax

(573) 335-1552

NPI assigned

Nov 15, 2012

Organization subpart

No

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

Authorized official

Name

Mark Jeffery McNabb, D.O.NPI 1942337522

Title

Owner

Phone

(573) 335-5057

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in MO

Enrollment records 1

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

Locations

Practitioners 1

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

• Mark Jeffery McNabb, D.O.

  • Internal Medicine Physician
  • Cape Girardeau, MO
  • NPI 1942337522
  Medicare reassignment NPD Authorized official

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

{
    "created_epoch": "1352937600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1352937600000",
    "number": "1750625844",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3260 LEXINGTON AVE",
            "city": "CAPE GIRARDEAU",
            "state": "MO",
            "postal_code": "637012609",
            "telephone_number": "573-335-5057",
            "fax_number": "573-335-1552"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3260 LEXINGTON AVE",
            "city": "CAPE GIRARDEAU",
            "state": "MO",
            "postal_code": "637012609",
            "telephone_number": "573-335-5057",
            "fax_number": "573-335-1552"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SOUTHERN MISSOURI INTERNAL MEDICINE, PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2012-11-15",
        "last_updated": "2012-11-15",
        "status": "A",
        "authorized_official_last_name": "MCNABB",
        "authorized_official_first_name": "MARK",
        "authorized_official_middle_name": "JEFFERY",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "573-335-5057",
        "authorized_official_credential": "D.O."
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Internal Medicine",
            "state": "MO",
            "license": "DO100129",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "203716006",
            "state": "MO"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Southeast Missouri Surgery Center LLC
• Southeast Missouri University
• Southeast Mo Area Agency on Aging
• Southeast Mo ENT Consultants LTD
• Southern Cross Medical Services Inc
• Keandra Speakman, APRN, FNP
• Speech Language Pathology of Missouri LLC
• Rachel Speer
• Paul Spence, M.D.
• Terry Michael Spence, DDS

• Internal Medicine Physician in Cape Girardeau, MO
• Providers in Cape Girardeau, MO by specialty
• Internal Medicine Physician in Missouri

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 15, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.