MARINO PHILLIPS AND EARLY CLINIC LLC (NPI# 1487820254) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1487820254 |
| Entity Type | Organization |
| Organization Name | MARINO PHILLIPS AND EARLY CLINIC LLC |
| Other Organization Name | CROWN FAMILY MEDICINE LLC |
| Practice Address |
1 Crown Dr Ste 200 Kirksville MO 63501-2510 |
| Mailing Address |
1 Crown Dr Ste 200 P O Box R Kirksville MO 63501-2510 |
| Practice Telephone | 6606652846 |
| Mailing Telephone | 6606652846 |
| Enumeration Date | 2008-05-01 |
| Last Update Date | 2010-07-20 |
| Authorized Official Name | KIMBERLY D SWISHER (BUSINESS MANAGER) |
| Authorized Official Telephone | 6606652846 |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 207Q00000X | Family Medicine | MO | Allopathic & Osteopathic Physicians |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| MO | BLUE CROSS BLUE SHIELD | 113296 | 01 |
| MO | 503873408 | 05 |
| Other Name | Type Code |
|---|---|
| CROWN FAMILY MEDICINE LLC | Doing Business As Name - Organization |
| Street Address |
1 CROWN DR STE 200 |
| City | KIRKSVILLE |
| State | MO |
| Zip Code | 63501-2510 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1578188959 | Brandi Ann Tague | Nurse Practitioner | 1 Crown Dr Ste 200, Kirksville, MO 63501-2510 | 2020-06-11 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1245855642 | Tiffany Anna Athon | Pharmacist | Hy-vee Pharmacy, 500 N Baltimore, Kirksville, MO 63501 | 2020-06-11 |
| 1649829425 | Jillian Jo Pulis | Speech-Language Pathologist | 1300 S Cottage Ave, Kirksville, MO 63501 | 2019-09-05 |
| 1023662319 | Leah Dawn Murphy | Occupational Therapy Assistant | 1705 E La Harpe St, Kirksville, MO 63501 | 2019-07-25 |
| 1902302912 | Brittney Frances Snelling | Specialist/Technologist | 26820 State Hwy 11, Kirksville, MO 63501 | 2018-03-30 |
| 1063931434 | Kara Wehmeyer | Specialist/Technologist | 100 East Normal, Kirksville, MO 63501 | 2017-09-16 |
| 1285080796 | Hawkins Boone Mecham | General Practice | 407 S Main St # 2, Kirksville, MO 63501 | 2016-05-13 |
| 1003287848 | Lacosta Gaines | Nurse Practitioner | 1607 South Baltimore, Kirksville, MO 63501 | 2015-10-19 |
| 1427442573 | Madi Hoppe | Specialist/Technologist | 23571 Crest Trail, Kirksville, MO 63501 | 2015-03-26 |
| 1407247133 | High Hope Employment Services, Inc. | Day Training, Developmentally Disabled Services | 906 East Shepherd Avenue, Kirksville, MO 63501 | 2015-02-17 |
| 1497069694 | Ella Marie Callison | Physician Assistant | 1611 S Baltimore St Ste A, Kirksville, MO 63501 | 2010-07-29 |
| Find all providers in zip 63501 | ||||
| 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 |
|---|---|---|---|---|
| 1205044146 | Justin David Puckett | Family Medicine | 2004 N Baltimore St Ste A, Kirksville, MO 63501-5107 | 2007-05-21 |
| 1356467898 | Robert A Parsonson | Family Medicine | 401 S. Baltimore Street, Kirksville, MO 63501-3725 | 2007-03-22 |
| 1548339484 | Ferrel A Moots | Family Medicine | 24252 State Highway 11, Kirksville, MO 63501 | 2006-11-07 |
| 1316045677 | Robert W Sparks | Family Medicine | 2200 S Halliburton St, Kirksville, MO 63501-4651 | 2006-09-20 |
| 1972609279 | John Robert Sparks | Family Medicine | 1410 Crown Drive, Kirksville, MO 63501-0703 | 2006-09-15 |
| 1063498210 | Ronald Leland Phillips | Family Medicine | 1 Crown Dr, Suite 200, Kirksville, MO 63501-2510 | 2005-12-20 |
| 1316922214 | Melanie S. Grgurich | Family Medicine | 1506 Crown Dr, Kirksville, MO 63501-2553 | 2005-12-13 |
| 1841275740 | Wayne R Hawkins | Family Medicine | 1510 Crown Dr, Kirksville, MO 63501-2553 | 2005-12-13 |
| 1093790966 | Gemma A Ciesemier | Family Medicine | 610 Rosewood Dr, Kirksville, MO 63501-2477 | 2005-12-13 |
| 1477538379 | John R Knudsen | Family Medicine | 600 W. Jefferson, Kirksville, MO 63501 | 2005-12-13 |
| Find all providers in KIRKSVILLE | ||||
| City | KIRKSVILLE |
| Zip Code | 63501 |
Please comment or provide details below to improve the information on MARINO PHILLIPS AND EARLY CLINIC LLC.
| 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.