Provider Demographics
NPI:1851504013
Name:VO MEDICAL CLINIC, P.C.
Entity Type:Organization
Organization Name:VO MEDICAL CLINIC, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN/PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:THANH
Authorized Official - Middle Name:DUY
Authorized Official - Last Name:VO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:314-580-6990
Mailing Address - Street 1:486 N CHURCH ST
Mailing Address - Street 2:
Mailing Address - City:SULLIVAN
Mailing Address - State:MO
Mailing Address - Zip Code:63080-1568
Mailing Address - Country:US
Mailing Address - Phone:573-468-5858
Mailing Address - Fax:573-468-5995
Practice Address - Street 1:486 N CHURCH ST
Practice Address - Street 2:
Practice Address - City:SULLIVAN
Practice Address - State:MO
Practice Address - Zip Code:63080-1568
Practice Address - Country:US
Practice Address - Phone:573-468-5858
Practice Address - Fax:573-468-5995
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-07
Last Update Date:2010-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MOR2C82174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MOA24241Medicare UPIN