Provider Demographics
NPI:1316205206
Name:THEODOSIA FAMILY MEDICAL CLINIC LLC
Entity Type:Organization
Organization Name:THEODOSIA FAMILY MEDICAL CLINIC LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER OF CLINIC
Authorized Official - Prefix:
Authorized Official - First Name:LISA
Authorized Official - Middle Name:A
Authorized Official - Last Name:SCHOFIELD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:417-273-2300
Mailing Address - Street 1:4900 ST HWY 160
Mailing Address - Street 2:SUITE 2
Mailing Address - City:THEODOSIA
Mailing Address - State:MO
Mailing Address - Zip Code:65761-6539
Mailing Address - Country:US
Mailing Address - Phone:417-273-2300
Mailing Address - Fax:417-273-2316
Practice Address - Street 1:4900 ST HWY. 160
Practice Address - Street 2:SUITE 2
Practice Address - City:THEODOSIA
Practice Address - State:MO
Practice Address - Zip Code:65761-6539
Practice Address - Country:US
Practice Address - Phone:417-273-2300
Practice Address - Fax:417-273-2316
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-04-27
Last Update Date:2013-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR1300XAmbulatory Health Care FacilitiesClinic/CenterRural Health