Provider Demographics
NPI:1457503609
Name:BOWLING GREEN ARTHRITIS & RHEUMATOLOGY CLINIC P C
Entity Type:Organization
Organization Name:BOWLING GREEN ARTHRITIS & RHEUMATOLOGY CLINIC P C
Other - Org Name:NORTH MISSOURI RHEUMATOLOGY CLINIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:INTERNAL MEDICINE DOCTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:KINIM
Authorized Official - Middle Name:I
Authorized Official - Last Name:SMITH
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:573-221-0304
Mailing Address - Street 1:3817 MCMASTERS AVE
Mailing Address - Street 2:SUITE 150
Mailing Address - City:HANNIBAL
Mailing Address - State:MO
Mailing Address - Zip Code:63401-2488
Mailing Address - Country:US
Mailing Address - Phone:573-221-0304
Mailing Address - Fax:573-221-0308
Practice Address - Street 1:3817 MCMASTERS AVE
Practice Address - Street 2:SUITE 150
Practice Address - City:HANNIBAL
Practice Address - State:MO
Practice Address - Zip Code:63401-2488
Practice Address - Country:US
Practice Address - Phone:573-221-0304
Practice Address - Fax:573-221-0308
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-10-21
Last Update Date:2015-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO119287207RR0500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RR0500XAllopathic & Osteopathic PhysiciansInternal MedicineRheumatologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO000095293Medicare PIN