MATTHEW J TIEFENBRUNN (NPI# 1457393712) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1457393712 |
| Entity Type | Individual |
| Full Name | MATTHEW J TIEFENBRUNN |
| Credential | M.D. |
| Practice Address |
1326 S Service Rd W Ste 10 Sullivan MO 63080-2306 |
| Practice Telephone | (573) 468-4455 |
| Mailing Telephone | (573) 468-4455 |
| Enumeration Date | 2006-06-12 |
| Last Update Date | 2017-09-20 |
| Gender Code | M |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 207Q00000X | Family Medicine | 117988 | MO | Allopathic & Osteopathic Physicians |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| MO | 1457393712 | 05 | |
| RAILROAD MEDICARE | 080140048 | 01 | |
| MO | 203922505 | 05 |
| Street Address |
1326 S SERVICE RD W STE 10 |
| City | SULLIVAN |
| State | MO |
| Zip Code | 63080-2306 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1215462999 | Kamealya Leah Farrell | Nurse Practitioner | 1326 S Service Rd W Ste 10, Sullivan, MO 63080 | 2017-05-01 |
| 1417169855 | Barbara L Blaue | Nurse Practitioner | 1326 S Service Rd W Ste 10, Sullivan, MO 63080-2306 | 2007-05-06 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1669896650 | Lindsay Nicole Arnette | Physical Therapist | 940 Mattox Drive, Meramec Nursing Center, Sullivan, MO 63080 | 2014-02-11 |
| 1407099500 | Victorian Manor of Sullivan | Assisted Living Facility | 1250 East Springfield Rd, Sullivan, MO 63080 | 2009-04-20 |
| 1578729992 | Bio-medical Applications of Missouri, Inc. | Clinic/Center | 123 Progress Parkway, Sullivan, MO 63080 | 2008-08-05 |
| 1386826089 | Sellers Family Chiropractic PC | Chiropractor | 405 Wal Mart Drive, Sullivan, MO 63080 | 2007-12-04 |
| 1740495282 | Tasha Marie Rodriguez | Physical Therapist | 107 Congress Dr., Sullivan, MO 63080 | 2007-05-10 |
| 1033261649 | Clyde William Sellers II | Chiropractor | 405 Walmart Dr., Sullivan, MO 63080 | 2007-01-17 |
| 1407954209 | Sara Skidmore | Occupational Therapist | 2022 Phoenix Drive, Sullivan, MO 63080 | 2006-09-20 |
| 1083724116 | Sharon A Titter | Physical Therapist | 107 Progress Dr, Sullivan, MO 63080 | 2006-08-30 |
| 1437135571 | Thanh Duy Vo | Pediatrics | 486 N Church St, Sullivan, MO 63080 | 2005-12-20 |
| 1508849316 | Air Evac Ems Inc | Ambulance | 673 Sappington Bridge Rd, Sullivan, MO 63080 | 2005-11-25 |
| Find all providers in zip 63080 | ||||
| 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 |
|---|---|---|---|---|
| 1568628915 | Barbara Ann Reed | Family Medicine | 2186 N Hospital Blvd Ste 2, Sullivan, IN 47882-7654 | 2008-08-05 |
| 1922295815 | Patients First Health Care LLC | Family Medicine | 102 Grande Ctr, Sullivan, MO 63080-1266 | 2007-09-25 |
| 1548337942 | Premier Health Center, L.L.C. | Family Medicine | 102 Progress Pkwy, Sullivan, MO 63080-2359 | 2006-11-29 |
| 1578633194 | Mary Ann Chavez | Family Medicine | 1120 N Section St, Sullivan Medical Clinic, Sullivan, IN 47882-9200 | 2006-11-09 |
| 1912924630 | Medical Income Management Corp | Family Medicine | 101 W Jefferson St, Sullivan, IL 61951-1914 | 2006-07-17 |
| 1811973944 | Yasuo Ishida | Family Medicine | 102 Progress Pkwy # A, Sullivan, MO 63080-2359 | 2005-12-20 |
| 1477555738 | Glen E Dust | Family Medicine | 2 W Adams St, Sullivan, IL 61951-1943 | 2005-06-01 |
| 1952304123 | Carl F. Conwell | Family Medicine | 2229 Mary Sherman Dr, Sullivan, IN 47882-7633 | 2005-05-23 |
| 1497363303 | Sullivan County Community Hospital | Family Medicine | 2186 N Hospital Blvd Ste 2, Sullivan, IN 47882-7654 | 2020-07-16 |
| 1306466263 | Reed Pharmacies, LLC | Family Medicine | 17 N Hamilton St, Sullivan, IL 61951-1452 | 2020-04-21 |
| Find all providers in SULLIVAN | ||||
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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.