Provider Demographics
NPI:1841737798
Name:PHILLIP KINTNER MD, LLC
Entity Type:Organization
Organization Name:PHILLIP KINTNER MD, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:PHILLIP
Authorized Official - Middle Name:
Authorized Official - Last Name:KINTNER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:573-664-1278
Mailing Address - Street 1:546 MAPLE VALLEY DR
Mailing Address - Street 2:
Mailing Address - City:FARMINGTON
Mailing Address - State:MO
Mailing Address - Zip Code:63640-1981
Mailing Address - Country:US
Mailing Address - Phone:573-664-1278
Mailing Address - Fax:573-664-1118
Practice Address - Street 1:546 MAPLE VALLEY DR
Practice Address - Street 2:
Practice Address - City:FARMINGTON
Practice Address - State:MO
Practice Address - Zip Code:63640-1981
Practice Address - Country:US
Practice Address - Phone:573-664-1278
Practice Address - Fax:573-664-1118
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-01-30
Last Update Date:2017-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2011017279261QM2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM2500XAmbulatory Health Care FacilitiesClinic/CenterMedical Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MOE18643Medicare UPIN