Provider Demographics
NPI:1528400173
Name:EMOLOGIC CLINIC, LLC
Entity Type:Organization
Organization Name:EMOLOGIC CLINIC, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PSYCHIATRIST
Authorized Official - Prefix:MR
Authorized Official - First Name:SHAHID
Authorized Official - Middle Name:
Authorized Official - Last Name:INSAF
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:417-243-7777
Mailing Address - Street 1:500 W. MAIN
Mailing Address - Street 2:STE 204
Mailing Address - City:BRANSON
Mailing Address - State:MO
Mailing Address - Zip Code:65616
Mailing Address - Country:US
Mailing Address - Phone:417-243-7777
Mailing Address - Fax:417-243-7778
Practice Address - Street 1:500 W. MAIN
Practice Address - Street 2:STE 204
Practice Address - City:BRANSON
Practice Address - State:MO
Practice Address - Zip Code:65616
Practice Address - Country:US
Practice Address - Phone:417-243-7777
Practice Address - Fax:417-243-7778
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:EMOLOGIC CLINIC LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2013-07-24
Last Update Date:2013-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2011026917163WP0809X
MO20050344722084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Multi-Specialty
No163WP0809XNursing Service ProvidersRegistered NursePsychiatric/Mental Health, AdultGroup - Multi-Specialty