Provider Demographics
NPI:1407841703
Name:MISSOURI CARDIOVASCULAR SPECIALISTS
Entity Type:Organization
Organization Name:MISSOURI CARDIOVASCULAR SPECIALISTS
Other - Org Name:MISSOURI HEART CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CHIEF EXECUTIVE OFFICER
Authorized Official - Prefix:MR
Authorized Official - First Name:ALLEN
Authorized Official - Middle Name:L
Authorized Official - Last Name:GOREE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:573-256-3010
Mailing Address - Street 1:1605 E BROADWAY
Mailing Address - Street 2:SUITE 300
Mailing Address - City:COLUMBIA
Mailing Address - State:MO
Mailing Address - Zip Code:65201-8023
Mailing Address - Country:US
Mailing Address - Phone:573-256-7700
Mailing Address - Fax:573-256-3071
Practice Address - Street 1:1605 E BROADWAY
Practice Address - Street 2:SUITE 300
Practice Address - City:COLUMBIA
Practice Address - State:MO
Practice Address - Zip Code:65201-8023
Practice Address - Country:US
Practice Address - Phone:573-256-7700
Practice Address - Fax:573-256-3071
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-09-13
Last Update Date:2009-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular DiseaseGroup - Multi-Specialty
No208G00000XAllopathic & Osteopathic PhysiciansThoracic Surgery (Cardiothoracic Vascular Surgery)Group - Multi-Specialty