Provider Demographics
NPI:1114163367
Name:BARTON MEDICAL CENTER LLC
Entity Type:Organization
Organization Name:BARTON MEDICAL CENTER LLC
Other - Org Name:BARTON FAMILY MEDICAL CENTER LLC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PHYSICIAN/PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ROD
Authorized Official - Middle Name:TROY
Authorized Official - Last Name:BARTON
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:417-839-3886
Mailing Address - Street 1:PO BOX 867
Mailing Address - Street 2:
Mailing Address - City:MOUNTAIN GROVE
Mailing Address - State:MO
Mailing Address - Zip Code:65711-0867
Mailing Address - Country:US
Mailing Address - Phone:417-839-3886
Mailing Address - Fax:417-962-4947
Practice Address - Street 1:1000 MAIN ST
Practice Address - Street 2:
Practice Address - City:CABOOL
Practice Address - State:MO
Practice Address - Zip Code:65689-9125
Practice Address - Country:US
Practice Address - Phone:417-839-3886
Practice Address - Fax:417-962-4947
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-12-17
Last Update Date:2009-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO113546261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO244666442Medicaid
MOG87208Medicare UPIN