Provider Demographics
NPI:1629290002
Name:JOHN C VANSTONE MD PC
Entity Type:Organization
Organization Name:JOHN C VANSTONE MD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:C
Authorized Official - Last Name:VANSTONE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:573-443-1531
Mailing Address - Street 1:2109 DICKINSON CT
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:MO
Mailing Address - Zip Code:65202
Mailing Address - Country:US
Mailing Address - Phone:573-814-2255
Mailing Address - Fax:
Practice Address - Street 1:3300 LEMONE INDUSTRIAL BLVD
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:MO
Practice Address - Zip Code:65201
Practice Address - Country:US
Practice Address - Phone:573-443-1531
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-03
Last Update Date:2009-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrologyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO506242007Medicaid
MO506242007Medicaid