Provider Demographics
NPI:1124238555
Name:MOBERLY MEDICAL CLINICS INC
Entity type:Organization
Organization Name:MOBERLY MEDICAL CLINICS INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR OF PROVIDER ENROLLMENT
Authorized Official - Prefix:
Authorized Official - First Name:DEBBIE
Authorized Official - Middle Name:
Authorized Official - Last Name:BREWER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:615-465-7626
Mailing Address - Street 1:136 SHELBY PLAZA RD
Mailing Address - Street 2:
Mailing Address - City:SHELBINA
Mailing Address - State:MO
Mailing Address - Zip Code:63468-1065
Mailing Address - Country:US
Mailing Address - Phone:573-588-1111
Mailing Address - Fax:573-588-1114
Practice Address - Street 1:136 SHELBY PLAZA RD
Practice Address - Street 2:
Practice Address - City:SHELBINA
Practice Address - State:MO
Practice Address - Zip Code:63468-1065
Practice Address - Country:US
Practice Address - Phone:573-588-1111
Practice Address - Fax:573-588-1114
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-23
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO207R00000X, 207RP1001X, 208000000X, 363A00000X, 363LF0000X, 207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
No207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
No207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary DiseaseGroup - Multi-Specialty
No208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Multi-Specialty
No363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantGroup - Multi-Specialty
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Multi-Specialty