Provider Demographics
NPI:1699468678
Name:DEVOE SMITH MEDICAL FOUNDATION
Entity type:Organization
Organization Name:DEVOE SMITH MEDICAL FOUNDATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BOARD MEMBER/ PROVIDER
Authorized Official - Prefix:MRS
Authorized Official - First Name:SONJA
Authorized Official - Middle Name:JEANNE
Authorized Official - Last Name:BOLLING
Authorized Official - Suffix:
Authorized Official - Credentials:FNP
Authorized Official - Phone:209-352-1881
Mailing Address - Street 1:23415 S SHAFFER RD
Mailing Address - Street 2:
Mailing Address - City:HARRISONVILLE
Mailing Address - State:MO
Mailing Address - Zip Code:64701-4061
Mailing Address - Country:US
Mailing Address - Phone:209-352-1881
Mailing Address - Fax:
Practice Address - Street 1:82 SOUTH STATE HIGHWAY F
Practice Address - Street 2:
Practice Address - City:GARDEN CITY
Practice Address - State:MO
Practice Address - Zip Code:64747-8125
Practice Address - Country:US
Practice Address - Phone:816-773-6256
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-05-26
Last Update Date:2023-05-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
No251V00000XAgenciesVoluntary or Charitable
No261QR1300XAmbulatory Health Care FacilitiesClinic/CenterRural HealthGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO1396150496OtherALL OTHER
MO1396150496Medicaid