Level 4 Medical Professional Corporation

Primary specialty

Point of ServiceTaxonomy code 305S00000X

License

2003017056 Issued in MO

Legal business name

LEVEL 4 MEDICAL PROFESSIONAL CORPORATION

Practice address

913 South St
Stockton, MO 65785-9381

Phone

(417) 809-8620

NPI assigned

Aug 5, 2010

Organization subpart

No

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

Authorized official

Name

David E Smock, MD

Title

Owner

Phone

(928) 503-4261

Specialties & licenses 1

Addresses

Other names 1

• Stockton Lake Walkin Clinic Doing business as

Locations

Practitioners 1

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

• Karam Abdelmasih, MD, AP

  • Family Medicine Physician
  • Festus, MO
  • NPI 1093288508
  NPD (past)

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

{
    "created_epoch": "1280966400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1422489600000",
    "number": "1861706434",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "913 SOUTH ST",
            "city": "STOCKTON",
            "state": "MO",
            "postal_code": "657859307",
            "telephone_number": "417-809-8620"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "913 SOUTH ST",
            "city": "STOCKTON",
            "state": "MO",
            "postal_code": "657859381",
            "telephone_number": "417-809-8620"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LEVEL 4 MEDICAL PROFESSIONAL CORPORATION",
        "organizational_subpart": "NO",
        "enumeration_date": "2010-08-05",
        "last_updated": "2015-01-29",
        "status": "A",
        "authorized_official_last_name": "SMOCK",
        "authorized_official_first_name": "DAVID",
        "authorized_official_middle_name": "E",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "928-503-4261",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "305S00000X",
            "taxonomy_group": "",
            "desc": "Point of Service",
            "state": "MO",
            "license": "2003017056",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Stockton Lake Walkin Clinic",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Debbie Lynn Haines, CPHT
• Katherine Marie Hicks, CPHT
• Michelle Hoffmann, PSYD
• Neale Wayne Johnson, D.D.S.
• Sarah Lynn Jones, RBT
• Mercy Hospital Springfield
• Ozarks Resource Group
• Taylor Phoenix
• Karen Sue Purtle, RPH
• Jason Pyle

• Point of Service in Stockton, MO
• Providers in Stockton, MO by specialty
• Point of Service in Missouri

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 29, 2015; 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.