Provider Demographics
NPI:1356510895
Name:KOENIG, DIANA LOUISE (DO)
Entity Type:Individual
Prefix:MRS
First Name:DIANA
Middle Name:LOUISE
Last Name:KOENIG
Suffix:
Gender:F
Credentials:DO
Other - Prefix:MS
Other - First Name:DIANA
Other - Middle Name:LOUISE
Other - Last Name:SPENGER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DO
Mailing Address - Street 1:1100 KENTUCKY AVENUE
Mailing Address - Street 2:OZARKS MEDICAL CENTER
Mailing Address - City:WEST PLAINS
Mailing Address - State:MO
Mailing Address - Zip Code:65775
Mailing Address - Country:US
Mailing Address - Phone:417-256-9111
Mailing Address - Fax:
Practice Address - Street 1:9104 STATE HWY 19
Practice Address - Street 2:OZARKS MEDICAL CENTER WINONA
Practice Address - City:WINONA
Practice Address - State:MO
Practice Address - Zip Code:65588
Practice Address - Country:US
Practice Address - Phone:573-325-4237
Practice Address - Fax:573-325-4996
Is Sole Proprietor?:No
Enumeration Date:2008-02-28
Last Update Date:2017-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2008008627207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO26D0679044OtherCLIA (LICKING)
MO26D0889777OtherCLIA (MOB)
MO597780303OtherRH MEDICAID
MO1356510895Medicaid
MO26D1050027OtherCLIA
MO26D1050027OtherCLIA
HO2000Medicare UPIN
MO268535Medicare Oscar/Certification
MO148990001Medicare PIN