Provider Demographics
NPI:1144406455
Name:BOONYASAI & BOONYASAI, M.D.P. C.
Entity Type:Organization
Organization Name:BOONYASAI & BOONYASAI, M.D.P. C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:BOONFU
Authorized Official - Middle Name:
Authorized Official - Last Name:BOONYASAI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:573-546-3929
Mailing Address - Street 1:200 ST. MARYS STREET PO BOX 527
Mailing Address - Street 2:LOWER LEVEL
Mailing Address - City:PILOT KNOB
Mailing Address - State:MO
Mailing Address - Zip Code:63663
Mailing Address - Country:US
Mailing Address - Phone:573-546-3929
Mailing Address - Fax:573-546-3962
Practice Address - Street 1:200 ST . MARYS STREET
Practice Address - Street 2:LOWER LEVEL
Practice Address - City:PILOT KNOB
Practice Address - State:MO
Practice Address - Zip Code:63663
Practice Address - Country:US
Practice Address - Phone:573-546-3929
Practice Address - Fax:573-546-3962
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-01-16
Last Update Date:2008-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO33967208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MOA11947Medicare UPIN