Hannibal Clinic Operations, L.L.C.

Primary specialty

Family Medicine PhysicianTaxonomy code 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

Last updated

Apr 18, 2022By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Mr. Michael J Bukstein, MD

Title

Physician Exec Director

Phone

(573) 231-3172

Specialties & licenses 1

Addresses

Other names 1

• Hannibal Clinic @ Palmyra Other name

Electronic endpoints 1

Member of 1

Organizations this organization is a member of, according to the National Provider Directory.

• Blessing Corporate Services, Inc

  dba Kahoka Medical Clinic

  • Rural Health Clinic/Center
  • Kahoka, MO
  • NPI 1245427608

  Member Of

  NPD member

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

{
    "created_epoch": "1136937600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1650240000000",
    "number": "1962481663",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "100 MEDICAL DR",
            "city": "HANNIBAL",
            "state": "MO",
            "postal_code": "634016877",
            "telephone_number": "573-221-5250",
            "fax_number": "573-231-3706"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1811 S MAIN ST",
            "city": "PALMYRA",
            "state": "MO",
            "postal_code": "634611961",
            "telephone_number": "573-769-2231",
            "fax_number": "573-769-3953"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "HANNIBAL CLINIC OPERATIONS, L.L.C.",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-01-11",
        "last_updated": "2022-04-18",
        "certification_date": "2022-04-18",
        "status": "A",
        "authorized_official_last_name": "BUKSTEIN",
        "authorized_official_first_name": "MICHAEL",
        "authorized_official_middle_name": "J",
        "authorized_official_title_or_position": "PHYSICIAN EXEC DIRECTOR",
        "authorized_official_telephone_number": "573-231-3172",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Family Medicine",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "CONNECT",
            "endpointTypeDescription": "CONNECT URL",
            "endpoint": "https://cobiusconnect.cobius.com:8291/Gateway/DocumentSubmission/2_0/NhinService/XDRRequest_Service",
            "affiliation": "Y",
            "endpointDescription": "2.16.840.1.113883.3.1068.1",
            "affiliationName": "Cobius Healthcare Solutions",
            "use": "OTHER",
            "useDescription": "Other",
            "useOtherDescription": "CMS esMD eMDR",
            "address_1": "2720 Dundee Rd # 302",
            "city": "Northbrook",
            "state": "IL",
            "country_code": "US",
            "postal_code": "600622609",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": [
        {
            "organization_name": "Hannibal Clinic @ Palmyra",
            "code": "5",
            "type": "Other Name"
        },
        {
            "organization_name": "Hannibal Clinic @ Palmyra",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

• Family Chiropractic Care, Inc.
• Amanda Elizabeth Gottman, DC
• Amber Nicole Gottman, NP-C
• Irina Nicole Gottman, PT
• Jazlin Rose Gottman
• Elizabeth Harmening, OTR/L
• Harmony Therapy and Wellness, LLC
• Hb4Therapy, LLC
• Holly Jo Henderson, MPT
• K.B. Therapy, Inc. (Priority Physical Therapy)

• Family Medicine Physician in Palmyra, MO
• Providers in Palmyra, MO by specialty
• Family Medicine Physician in Missouri

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 18, 2022; 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.