Provider Demographics
NPI:1033481163
Name:J K ESSMYER MEDICAL SERVICES LLC
Entity Type:Organization
Organization Name:J K ESSMYER MEDICAL SERVICES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SR MEMBER
Authorized Official - Prefix:DR
Authorized Official - First Name:JOSEPH
Authorized Official - Middle Name:KEITH
Authorized Official - Last Name:ESSMYER
Authorized Official - Suffix:SR
Authorized Official - Credentials:MD
Authorized Official - Phone:573-270-5092
Mailing Address - Street 1:933 COUNTY ROAD 389
Mailing Address - Street 2:
Mailing Address - City:WHITEWATER
Mailing Address - State:MO
Mailing Address - Zip Code:63785-6039
Mailing Address - Country:US
Mailing Address - Phone:573-833-6630
Mailing Address - Fax:
Practice Address - Street 1:300 MT AUBURN RD
Practice Address - Street 2:AUBURN SURGERY CENTER, INC
Practice Address - City:CAPE GIRARDEAU
Practice Address - State:MO
Practice Address - Zip Code:63703
Practice Address - Country:US
Practice Address - Phone:573-332-7881
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-02-06
Last Update Date:2012-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO31286261QA1903X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO200111615Medicaid
MOA13145Medicare UPIN
MO000095355Medicare Oscar/Certification