Provider Demographics
NPI:1083643100
Name:OSTEOPATHIC MEDICAL ARTS, LLC
Entity Type:Organization
Organization Name:OSTEOPATHIC MEDICAL ARTS, LLC
Other - Org Name:OSTEOPATHIC MEDICAL ASSOCIATES, LLC
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:BOSS
Authorized Official - Prefix:DR
Authorized Official - First Name:JERRY
Authorized Official - Middle Name:L
Authorized Official - Last Name:HAMAN
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:660-627-1812
Mailing Address - Street 1:PO BOX 661
Mailing Address - Street 2:
Mailing Address - City:KIRKSVILLE
Mailing Address - State:MO
Mailing Address - Zip Code:63501-0661
Mailing Address - Country:US
Mailing Address - Phone:660-627-1812
Mailing Address - Fax:660-627-4799
Practice Address - Street 1:27176 ST HWY 6 E
Practice Address - Street 2:
Practice Address - City:KIRKSVILLE
Practice Address - State:MO
Practice Address - Zip Code:63501
Practice Address - Country:US
Practice Address - Phone:660-627-1812
Practice Address - Fax:660-627-4799
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-01
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes204D00000XAllopathic & Osteopathic PhysiciansNeuromusculoskeletal Medicine & OMMGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO=========OtherTAX ID