Provider Demographics
NPI:1093289431
Name:MOSAIC MEDICAL CENTER - MARYVILLE
Entity Type:Organization
Organization Name:MOSAIC MEDICAL CENTER - MARYVILLE
Other - Org Name:MOSAIC FAMILY CARE - SAVANNAH
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR OF REIMBURSEMENT
Authorized Official - Prefix:
Authorized Official - First Name:DWIGHT
Authorized Official - Middle Name:R
Authorized Official - Last Name:CARVELL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:816-273-0473
Mailing Address - Street 1:301 E PRICE AVE STE A
Mailing Address - Street 2:
Mailing Address - City:SAVANNAH
Mailing Address - State:MO
Mailing Address - Zip Code:64485-2482
Mailing Address - Country:US
Mailing Address - Phone:816-432-0006
Mailing Address - Fax:816-432-0008
Practice Address - Street 1:301 E PRICE AVE STE A
Practice Address - Street 2:
Practice Address - City:SAVANNAH
Practice Address - State:MO
Practice Address - Zip Code:64485-2482
Practice Address - Country:US
Practice Address - Phone:816-432-0006
Practice Address - Fax:816-432-0008
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-01-18
Last Update Date:2019-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QR1300XAmbulatory Health Care FacilitiesClinic/CenterRural HealthGroup - Multi-Specialty
No207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
No207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
No208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Multi-Specialty
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGroup - Multi-Specialty
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Multi-Specialty
No363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatricsGroup - Multi-Specialty