Provider Demographics
NPI:1982863718
Name:PROMPT MEDICAL CLINIC INC
Entity Type:Organization
Organization Name:PROMPT MEDICAL CLINIC INC
Other - Org Name:MID-AMERICA INTERNAL MEDICINE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:ARPORN
Authorized Official - Middle Name:
Authorized Official - Last Name:SIRIWANGCHAI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:816-252-6647
Mailing Address - Street 1:1325 S NOLAND RD STE C
Mailing Address - Street 2:
Mailing Address - City:INDEPENDENCE
Mailing Address - State:MO
Mailing Address - Zip Code:64055-1346
Mailing Address - Country:US
Mailing Address - Phone:816-252-6647
Mailing Address - Fax:816-252-0012
Practice Address - Street 1:1325 S NOLAND RD STE C
Practice Address - Street 2:
Practice Address - City:INDEPENDENCE
Practice Address - State:MO
Practice Address - Zip Code:64055-1346
Practice Address - Country:US
Practice Address - Phone:816-252-6647
Practice Address - Fax:816-252-0012
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-06-06
Last Update Date:2008-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO118012363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute CareGroup - Single Specialty