Hannibal Clinic Operations, L.L.C.
Organization Active NPI Family Medicine Physician · Palmyra, MO
NPI 1962481663 · NPPES record last updated Apr 18, 2022
Key facts
- NPI
- 1962481663
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Family Medicine Physician 207Q00000X
- Legal business name
- HANNIBAL CLINIC OPERATIONS, L.L.C.
- Practice address
- 1811 S Main St
Palmyra, MO 63461-1961 - Phone
- (573) 769-2231
- Fax
- (573) 769-3953
- NPI assigned
- Jan 11, 2006
- Organization subpart
- No
Authorized official
- Name
- Mr. Michael J Bukstein, MD
- Title
- Physician Exec Director
- Phone
- (573) 231-3172
Member of 1
National Provider Directory
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Family Medicine Physician |
207Q00000X | Yes |
Addresses
Primary practice location
1811 S Main St
Palmyra, MO 63461-1961
Mailing address
100 Medical Dr
Hannibal, MO 63401-6877
Phone (573) 221-5250
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 500221007 | Medicaid | MO |
Other names
- Hannibal Clinic @ Palmyra
Electronic endpoints
| Type | Endpoint | Use | Affiliation |
|---|---|---|---|
| CONNECT URL | https://cobiusconnect.cobius.com:8291/Gateway/DocumentSubmission/2_0/NhinService/XDRRequest_Service | Other | Cobius Healthcare Solutions |
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- Elizabeth Harmening
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All providers in Palmyra, MO · Family Medicine 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 Apr 18, 2022. 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.