Provider Demographics
NPI:1639436181
Name:MISSOURI COLLEGE, INC.
Entity Type:Organization
Organization Name:MISSOURI COLLEGE, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CAMPUS DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:NICOLE
Authorized Official - Middle Name:
Authorized Official - Last Name:GRAMLICH
Authorized Official - Suffix:
Authorized Official - Credentials:MAOM
Authorized Official - Phone:314-768-7806
Mailing Address - Street 1:1405 S HANLEY RD
Mailing Address - Street 2:
Mailing Address - City:BRENTWOOD
Mailing Address - State:MO
Mailing Address - Zip Code:63144-2902
Mailing Address - Country:US
Mailing Address - Phone:314-768-7800
Mailing Address - Fax:314-768-7900
Practice Address - Street 1:1405 S HANLEY RD
Practice Address - Street 2:
Practice Address - City:BRENTWOOD
Practice Address - State:MO
Practice Address - Zip Code:63144-2902
Practice Address - Country:US
Practice Address - Phone:314-768-7800
Practice Address - Fax:314-768-7900
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-04-20
Last Update Date:2012-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO010357261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental