Charles Clayton Kindlesparger Jr.
Individual provider Active NPI Driver · Farmington, MO
NPI 1780415448 · NPPES record last updated Aug 13, 2024
Key facts
- NPI
- 1780415448
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Driver 172A00000X
- License
- S093187005 (MO)
- Practice address
- 1085 Maple St
Farmington, MO 63640-1955 - Phone
- (573) 756-5353
- NPI assigned
- Aug 13, 2024
- Sex
- Male
- Sole proprietor
- No
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| S093187005 | MO | MD | Driver |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Driver | 172A00000X | S093187005 | MO | Yes |
Addresses
Primary practice location
1085 Maple St
Farmington, MO 63640-1955
Mailing address
3309 S Kingshighway Blvd
Saint Louis, MO 63139-1101
Phone (314) 206-3700
Other providers in Farmington, MO
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Aug 13, 2024. 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.