Provider Demographics
NPI:1558108837
Name:BOONE PHYSICIAN SERVICES LLC
Entity type:Organization
Organization Name:BOONE PHYSICIAN SERVICES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:JARED
Authorized Official - Middle Name:
Authorized Official - Last Name:LONG
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:573-815-6245
Mailing Address - Street 1:606 E SPRING ST
Mailing Address - Street 2:
Mailing Address - City:BOONVILLE
Mailing Address - State:MO
Mailing Address - Zip Code:65233-1523
Mailing Address - Country:US
Mailing Address - Phone:660-882-3955
Mailing Address - Fax:660-882-3972
Practice Address - Street 1:606 E SPRING ST
Practice Address - Street 2:
Practice Address - City:BOONVILLE
Practice Address - State:MO
Practice Address - Zip Code:65233-1523
Practice Address - Country:US
Practice Address - Phone:660-882-3955
Practice Address - Fax:660-882-3972
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-07-12
Last Update Date:2024-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR1300XAmbulatory Health Care FacilitiesClinic/CenterRural Health