Provider Demographics
NPI:1760240139
Name:MARK STAMPEHL, MD LLC
Entity Type:Organization
Organization Name:MARK STAMPEHL, MD LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MARK
Authorized Official - Middle Name:
Authorized Official - Last Name:STAMPEHL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:573-305-2258
Mailing Address - Street 1:4312 SILVER VALLEY DR
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:MO
Mailing Address - Zip Code:65203-7297
Mailing Address - Country:US
Mailing Address - Phone:573-305-2258
Mailing Address - Fax:
Practice Address - Street 1:4312 SILVER VALLEY DR
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:MO
Practice Address - Zip Code:65203-7297
Practice Address - Country:US
Practice Address - Phone:573-305-2258
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-03-11
Last Update Date:2024-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM2500XAmbulatory Health Care FacilitiesClinic/CenterMedical Specialty