Provider Demographics
NPI:1891088001
Name:DOC IN A BOX LLC
Entity Type:Organization
Organization Name:DOC IN A BOX LLC
Other - Org Name:SIMMONS FAMILY PRACTICE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:SCOTT
Authorized Official - Middle Name:PATRICK
Authorized Official - Last Name:SIMMONS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:573-581-2348
Mailing Address - Street 1:1000 WEBSTER STREET
Mailing Address - Street 2:SUITE 101
Mailing Address - City:MEXICO
Mailing Address - State:MO
Mailing Address - Zip Code:65265-3298
Mailing Address - Country:US
Mailing Address - Phone:573-581-2348
Mailing Address - Fax:573-581-9447
Practice Address - Street 1:1000 WEBSTER STREET
Practice Address - Street 2:SUITE 101
Practice Address - City:MEXICO
Practice Address - State:MO
Practice Address - Zip Code:65265
Practice Address - Country:US
Practice Address - Phone:573-581-2348
Practice Address - Fax:573-581-9447
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-05-20
Last Update Date:2015-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2009007879261QP2300X, 261QR1300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
No261QR1300XAmbulatory Health Care FacilitiesClinic/CenterRural Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO505616706Medicaid