DOCTORS INN CLINIC LLC (NPI# 1114117306) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1114117306 |
| Entity Type | Organization |
| Organization Name | DOCTORS INN CLINIC LLC |
| Practice Address |
1112 South Byp Ste C Suite C Kennett MO 63857-3738 |
| Mailing Address |
1112 South Byp Suite C Kennett MO 63857-3738 |
| Practice Telephone | 5737171776 |
| Practice Fax Number | 5737171572 |
| Mailing Telephone | 5737171776 |
| Mailing Fax Number | 5737171572 |
| Enumeration Date | 2007-07-25 |
| Last Update Date | 2010-02-26 |
| Authorized Official Name | DEBBIE A WADE (NP) |
| Authorized Official Telephone | 5737171776 |
| Authorized Official Credential | NP |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 207Q00000X | Family Medicine | 2000148413 | MO | Allopathic & Osteopathic Physicians |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| MO | BLUE CROSS MISSOURI | 109494A-001 | 01 |
| MO | ARKANSAS MEDICAID | 150606001 | 01 |
| MO | BLUE CROSS ARKANSAS | SM707 | 01 |
| MO | 595409004 | 05 |
| Street Address |
1112 SOUTH BYP STE C SUITE C |
| City | KENNETT |
| State | MO |
| Zip Code | 63857-3738 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1992278139 | Fancilla Adams | Counselor | 925 State Highway V V, Kennett, MO 63857 | 2019-01-10 |
| 1962994418 | Kiana Alexis Brown | Behavior Technician | 925 Highway W, Kennett, MO 63857 | 2018-05-31 |
| 1568953636 | Doctors Health Group, Inc | Family Medicine | 1312 First Street, Kennett, MO 63857 | 2018-05-24 |
| 1003328873 | Ann Graf | Counselor | 925 Vv, Kennett, MO 63857 | 2017-11-01 |
| 1457872160 | Jessica Luster | Technician, Other | 1109 Jones St., Kennett, MO 63857 | 2017-07-03 |
| 1235669128 | Chandra Celeste Perkins-shannon | Case Manager/Care Coordinator | 925 Hwy V, Kennett, MO 63857 | 2017-06-14 |
| 1467991612 | Sarah Lobdell | Case Manager/Care Coordinator | 925 State Highway Vv, Kennett, MO 63857 | 2017-02-21 |
| 1881132900 | Brandy Rios | Community Health Worker | 935 State Hwy Vv, Kennett, MO 63857 | 2017-02-09 |
| 1295272060 | Johnny Marie Johnson | Case Manager/Care Coordinator | 925 Hwy Vv Family Counseling Center, Kennett, MO 63857 | 2017-01-31 |
| 1043756364 | Heather Bowman | Case Manager/Care Coordinator | 875 Hwy Vv, Kennett, MO 63857 | 2017-01-10 |
| Find all providers in zip 63857 | ||||
| Taxonomy Code | 207Q00000X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Family Medicine |
| Family Medicine is the medical specialty which is concerned with the total health care of the individual and the family. It is the specialty in breadth which integrates the biological, clinical, and behavioral sciences. The scope of family medicine is not limited by age, sex, organ system, or disease entity. |
| Notes: Source: American Board of Family Medicine [1/1/2007: changed title; 7/1/2007: added definition, added source; 7/1/2017: modified definition] - Note: The American Osteopathic Board of Family Physicians certification includes extensive use of Osteopathic Manipulative Treatment (OMT), which integrates the biological, clinical, and behavioral sciences. - Additional Resources: American Board of Family Medicine, www.theabfm.org. American Osteopathic Board of Family Physicians, www.osteopathic.org/certification - Board certification for Medical Doctors (MDs) is provided by the American Board of Family Medicine. Board certification for Doctors of Osteopathy (DOs) is provided by the American Osteopathic Board of Family Physicians or the American Board of Family Medicine. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1568953636 | Doctors Health Group, Inc | Family Medicine | 1312 First Street, Kennett, MO 63857 | 2018-05-24 |
| 1679706956 | Mcpherson Medical and Diagnostic, LLC | Family Medicine | 901 W Commercial St, Kennett, MO 63857-1100 | 2009-09-02 |
| 1689815201 | Karl Erik Shanstrom | Family Medicine | 900 State Route Vv, Kennett, MO 63857-3834 | 2009-03-11 |
| 1649390683 | Jennifer R Sellman | Family Medicine | 1061 Jones St, Kennett, MO 63857-3866 | 2007-03-31 |
| 1700826153 | Donald G Blagdon | Family Medicine | 501 Teaco Road, Ste B, Kennett, MO 63857 | 2006-06-07 |
| 1922070903 | Massey Family Care LLC | Family Medicine | 304 Teaco Rd, Ste B, Kennett, MO 63857 | 2006-02-03 |
| 1477091890 | Pemiscot County Memorial Hospital | Family Medicine | 105 E Washington St, Kennett, MO 63857-2041 | 2017-02-06 |
| 1629511415 | Kennett Pediatrics and Asolescents Medicine LLC | Family Medicine | 211 Teaco Rd, Kennett, MO 63857-3236 | 2016-11-28 |
| 1801201520 | Kennett Hma LLC | Family Medicine | 1231 1st St, Suite 5, Kennett, MO 63857-2527 | 2014-06-23 |
| 1043485873 | Massey Family Care | Family Medicine | 304 Teaco Rd, Suite B, Kennett, MO 63857-3266 | 2008-04-23 |
| Find all providers in KENNETT | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.