Provider Demographics
NPI:1003951062
Name:COLUMBIA FAMILY MEDICAL GROUP, INC
Entity Type:Organization
Organization Name:COLUMBIA FAMILY MEDICAL GROUP, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:EVA
Authorized Official - Middle Name:M
Authorized Official - Last Name:TRABUE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:573-446-0037
Mailing Address - Street 1:303 N KEENE ST
Mailing Address - Street 2:SUITE 301
Mailing Address - City:COLUMBIA
Mailing Address - State:MO
Mailing Address - Zip Code:65201-7193
Mailing Address - Country:US
Mailing Address - Phone:573-449-0808
Mailing Address - Fax:573-442-1331
Practice Address - Street 1:303 N KEENE ST
Practice Address - Street 2:SUITE 301
Practice Address - City:COLUMBIA
Practice Address - State:MO
Practice Address - Zip Code:65201-7193
Practice Address - Country:US
Practice Address - Phone:573-449-0808
Practice Address - Fax:573-442-1331
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-20
Last Update Date:2009-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO004011255Medicare PIN
MO000011255Medicare PIN
MO003011255Medicare PIN
MO967141255Medicare PIN
MO926951255Medicare PIN
MO014011255Medicare PIN
MO005011255Medicare PIN