BOLIVAR OB/GYN (NPI# 1720402175) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1720402175 |
| Entity Type | Organization |
| Organization Name | BOLIVAR OB/GYN |
| Other Organization Name | BOLIVAR OB/GYN |
| Practice Address |
1165 N Butterfield Rd Suite B Bolivar MO 65613-1056 |
| Practice Telephone | 4177778131 |
| Practice Fax Number | 4177778892 |
| Mailing Telephone | 4177778131 |
| Mailing Fax Number | 4177778892 |
| Enumeration Date | 2014-02-05 |
| Last Update Date | 2014-02-05 |
| Authorized Official Name | MRS. DEBRA R VOLCKO (BUSINESS MANAGER) |
| Authorized Official Telephone | 4177778131 |
| Authorized Official Credential | MT(ASCP) CSC, CO |
| Is Organization Subpart | Y |
| Parent Organization Name | SIGNATURE MEDICAL GROUP |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 207V00000X | Obstetrics & Gynecology | 2013021740 | MO | Allopathic & Osteopathic Physicians |
| Other Name | Type Code |
|---|---|
| Bolivar OB/GYN | Doing Business As Name - Organization |
| Street Address |
1165 N BUTTERFIELD RD SUITE B |
| City | BOLIVAR |
| State | MO |
| Zip Code | 65613-1056 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1861448854 | Dana M Meents | Obstetrics & Gynecology | 1165 N Butterfield Rd, Bolivar, MO 65613-1056 | 2006-05-25 |
| 1396907614 | Signature Medical Group, Inc | Durable Medical Equipment & Medical Supplies | 1165 N Butterfield Rd, Bolivar, MO 65613-1056 | 2008-06-27 |
| 1508979402 | Maida Patricia Baugh | Pediatrics | 1165 N Butterfield Rd, Bolivar, MO 65613-1056 | 2006-08-16 |
| 1366481434 | Charles K Burlison | Obstetrics & Gynecology | 1165 N Butterfield Rd, Bolivar, MO 65613-1056 | 2006-06-05 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1891301552 | Casablanca Care Center, LLC | Home Health | 524 S. Albany Avenue, Bolivar, MO 65613 | 2020-09-18 |
| 1669087045 | Revive Medical LLC | Durable Medical Equipment & Medical Supplies | 5000, S Scenic, Bolivar, MO 65613 | 2020-09-11 |
| 1669097119 | Melanie Nicole Beckham | Nurse Practitioner | 1100 South Springfield Ave, Suite B, Bolivar, MO 65613 | 2020-06-10 |
| 1932754744 | Caitlin M Williams | Specialist/Technologist | 1260 S Pike Avenue, Bolivar, MO 65613 | 2019-08-08 |
| 1073022406 | Jacquelyn Rose Kemnic | Dietitian, Registered | Heart Center, 1500 N Oakland Ave, Willard, MO 65613 | 2017-09-28 |
| 1164897161 | Ozarks Resource Group | Clinic/Center | 203 E. Broadway St., Bolivar, MO 65613 | 2015-12-02 |
| 1962895292 | Professional Christian Counseling | Counselor | 4888 S 139th Road, Bolivar, MO 65613 | 2015-03-11 |
| 1073916573 | Scott Leslie Dennis | Physician Assistant | 1500 North Oakland Ave, Citizens Memorial Hospital, Bolivar, MO 65613 | 2014-09-29 |
| 1053712109 | Citizens Memorial Hospital District | Pharmacy | 1301-b North Oakland, Bolivar, MO 65613 | 2014-09-09 |
| 1740680453 | Jamee M Stimpson | Occupational Therapist | 454 S. Main Avenue, Bolivar, MO 65613 | 2014-08-29 |
| Find all providers in zip 65613 | ||||
| Taxonomy Code | 207V00000X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Obstetrics & Gynecology |
| An obstetrician/gynecologist possesses special knowledge, skills and professional capability in the medical and surgical care of the female reproductive system and associated disorders. This physician serves as a consultant to other physicians and as a primary physician for women. |
| Notes: Source: American Board of Medical Specialties, 2007. www.abms.org [7/1/2007: definiton added, source added; 7/1/2011: modified source] - Additional Resources: American Board of Obstetrics and Gynecology, 2007. http://www.abog.org/. American Osteopathic Board of Obstetrics and Gynecology, 2007. http://www.osteopathic.org/certification - Board certification for Medical Doctors (MDs) is provided by the American Board of Obstetrics and Gynecology. Board certification for Doctors of Osteopathy (DOs) is provided by the American Osteopathic Board of Obstetrics and Gynecology. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1285860551 | Sarah B Kallberg | Obstetrics & Gynecology | 1165 N Butterfield, Suite B, Bolivar, MO 65613-1165 | 2009-06-01 |
| 1861448854 | Dana M Meents | Obstetrics & Gynecology | 1165 N Butterfield Rd, Bolivar, MO 65613-1056 | 2006-05-25 |
| 1023306388 | Ashley Michele Lane | Obstetrics & Gynecology | 1195 N Oakland Ave, Bolivar, MO 65613-8095 | 2011-07-20 |
| 1366481434 | Charles K Burlison | Obstetrics & Gynecology | 1165 N Butterfield Rd, Bolivar, MO 65613-1056 | 2006-06-05 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1700403334 | Sarah Mai Truong | Obstetrics & Gynecology | 402 N Keene St # Dc570.00, Columbia, MO 65201-6986 | 2020-06-30 |
| 1962049593 | Michael Wayne Mccullough | Obstetrics & Gynecology | 500 N Keene St Ste 400, Columbia, MO 65201-8104 | 2019-12-02 |
| 1144881509 | Stephanie Barata | Obstetrics & Gynecology | 402 N Keene St Ste 402, Columbia, MO 65201-6986 | 2019-06-26 |
| 1447814181 | Obstetrical Associates of St. Luke's, LLC | Obstetrics & Gynecology | 224 S Woods Mill Rd Ste 750s, Chesterfield, MO 63017-3623 | 2019-04-29 |
| 1508328782 | Lauren Marie Rackovan | Obstetrics & Gynecology | 1011 Bowles Ave Ste 215, Fenton, MO 63026-2387 | 2019-04-04 |
| 1144798737 | Frg Rlt Holdings, Inc. | Obstetrics & Gynecology | 1747 Smizer Station Rd Ste 1, Fenton, MO 63026-2784 | 2018-11-13 |
| 1568984367 | Gsh Lab LLC | Obstetrics & Gynecology | 621 S New Ballas Rd Ste 1017b, Saint Louis, MO 63141-8264 | 2017-07-13 |
| 1851825715 | Sydni Fazenbaker Crowell | Obstetrics & Gynecology | 621 S New Ballas Rd Ste 2009b, Saint Louis, MO 63141 | 2017-04-18 |
| 1063945517 | Donald R Jones Enterprises, LLC | Obstetrics & Gynecology | 225 Physicians Park Ste 300, Poplar Bluff, MO 63901-3930 | 2017-04-11 |
| 1184157984 | Robert Mcdavid | Obstetrics & Gynecology | 3609 Arbor Ct, Columbia, MO 65201-6542 | 2017-04-07 |
| Find all providers with the same taxonomy | ||||
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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.