Provider Demographics
NPI:1568630093
Name:CENTRAL MISSOURI CARDIOVASCULAR ASSOCIATES, INC.
Entity Type:Organization
Organization Name:CENTRAL MISSOURI CARDIOVASCULAR ASSOCIATES, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:COLIN
Authorized Official - Middle Name:ERNEST
Authorized Official - Last Name:BAILEY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:573-302-0032
Mailing Address - Street 1:5780 OSAGE BEACH PKWY
Mailing Address - Street 2:SUITE 200
Mailing Address - City:OSAGE BEACH
Mailing Address - State:MO
Mailing Address - Zip Code:65065-3188
Mailing Address - Country:US
Mailing Address - Phone:573-302-0032
Mailing Address - Fax:573-302-0378
Practice Address - Street 1:5780 OSAGE BEACH PKWY
Practice Address - Street 2:SUITE 200
Practice Address - City:OSAGE BEACH
Practice Address - State:MO
Practice Address - Zip Code:65065-3188
Practice Address - Country:US
Practice Address - Phone:573-302-0032
Practice Address - Fax:573-302-0378
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-02-19
Last Update Date:2013-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO105982208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO207677733Medicaid
MO000094233Medicare PIN
MO207677733Medicaid