Provider Demographics
NPI:1811992951
Name:EMERGENCY PHYSICIANS OF MID MISSOURI PC
Entity type:Organization
Organization Name:EMERGENCY PHYSICIANS OF MID MISSOURI PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT PROVIDER
Authorized Official - Prefix:DR
Authorized Official - First Name:RANDALL
Authorized Official - Middle Name:E
Authorized Official - Last Name:MUELLER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:573-445-7272
Mailing Address - Street 1:1705 N STADIUM BLVD
Mailing Address - Street 2:SUITE B
Mailing Address - City:COLUMBIA
Mailing Address - State:MO
Mailing Address - Zip Code:65202-1305
Mailing Address - Country:US
Mailing Address - Phone:573-445-7272
Mailing Address - Fax:573-445-7285
Practice Address - Street 1:1600 E BROADWAY
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:MO
Practice Address - Zip Code:65201-5844
Practice Address - Country:US
Practice Address - Phone:573-815-3573
Practice Address - Fax:573-815-6295
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-06-16
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO100030OtherANTHEM BLUE CROSS