Hannibal Clinic Operations, L.L.C.
Family Medicine in Palmyra, MO. Organization (NPI-2).
NPI number1962481663
StatusActive
Last updated in NPPESApr 18, 2022
Details
- NPI
- 1962481663
- Entity type
- Organization (NPI-2)
- Legal business name
- Hannibal Clinic Operations, L.L.C.
- Organization subpart
- No
- Enumeration date
- Jan 11, 2006
- Certification date
- Apr 18, 2022
- Last updated
- Apr 18, 2022
Taxonomy and licenses
| Taxonomy code | Description | License | State | Primary |
|---|---|---|---|---|
| 207Q00000X | Family Medicine | – | – | Yes |
Other names
- Hannibal Clinic @ Palmyra (Other Name)
Practice location
1811 S Main StPalmyra, MO 63461-1961
Phone 573-769-2231 · Fax 573-769-3953
Mailing address
100 Medical DrHannibal, MO 63401-6877
Phone 573-221-5250 · Fax 573-231-3706
Authorized official
Michael J Bukstein
Physician Exec Director
5732313172
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