Provider Demographics
NPI:1073600334
Name:MISSOURI STATE UNIVERSITY
Entity Type:Organization
Organization Name:MISSOURI STATE UNIVERSITY
Other - Org Name:BILL AND LUCILLE MAGERS FAMILY HEALTH AND WELLNESS CENTER
Other - Org Type:Other Name
Authorized Official - Title/Position:BUSINESS OFFICE COORDINATOR
Authorized Official - Prefix:
Authorized Official - First Name:CLARA
Authorized Official - Middle Name:LYNETTE
Authorized Official - Last Name:WALKER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:417-836-4040
Mailing Address - Street 1:901 S NATIONAL
Mailing Address - Street 2:MISSOURI STATE UNIVERSITY
Mailing Address - City:SPRINGFIELD
Mailing Address - State:MO
Mailing Address - Zip Code:65897-0001
Mailing Address - Country:US
Mailing Address - Phone:417-836-4000
Mailing Address - Fax:417-836-4133
Practice Address - Street 1:715 S FLORENCE
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:MO
Practice Address - Zip Code:65897
Practice Address - Country:US
Practice Address - Phone:417-836-4000
Practice Address - Fax:417-836-4133
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-06
Last Update Date:2018-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
No103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Multi-Specialty
No133N00000XDietary & Nutritional Service ProvidersNutritionistGroup - Multi-Specialty
No207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
No207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Multi-Specialty
No207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryGroup - Multi-Specialty
No2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Multi-Specialty
No2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic RadiologyGroup - Multi-Specialty