Provider Demographics
NPI:1285803353
Name:BIRCHEM, JESSICA ANNE (DO)
Entity type:Individual
Prefix:DR
First Name:JESSICA
Middle Name:ANNE
Last Name:BIRCHEM
Suffix:
Gender:F
Credentials:DO
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Mailing Address - Street 1:2115 S FREMONT AVE
Mailing Address - Street 2:SUITE 4300
Mailing Address - City:SPRINGFIELD
Mailing Address - State:MO
Mailing Address - Zip Code:65804
Mailing Address - Country:US
Mailing Address - Phone:417-829-3911
Mailing Address - Fax:417-829-3924
Practice Address - Street 1:2115 S FREMONT AVE
Practice Address - Street 2:SUITE 4300
Practice Address - City:SPRINGFIELD
Practice Address - State:MO
Practice Address - Zip Code:65804-2239
Practice Address - Country:US
Practice Address - Phone:417-820-3911
Practice Address - Fax:417-820-3924
Is Sole Proprietor?:No
Enumeration Date:2008-02-22
Last Update Date:2017-07-05
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MO2004022163207RC0000X, 207RI0011X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0011XAllopathic & Osteopathic PhysiciansInternal MedicineInterventional Cardiology
No207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
P00836336OtherRAILROAD MEDICARE
AR182624003Medicaid
MO1285803353Medicaid
MO431560263OtherTRICARE WEST
MO132680144Medicare PIN
MO1285803353Medicaid