Provider Demographics
NPI:1881888329
Name:CONLEY CLINIC LLC
Entity type:Organization
Organization Name:CONLEY CLINIC LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:TESS
Authorized Official - Middle Name:LYNNE
Authorized Official - Last Name:BIRD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:660-263-3185
Mailing Address - Street 1:1145 S MORLEY ST
Mailing Address - Street 2:STE 5
Mailing Address - City:MOBERLY
Mailing Address - State:MO
Mailing Address - Zip Code:65270-1948
Mailing Address - Country:US
Mailing Address - Phone:660-263-3185
Mailing Address - Fax:660-263-7271
Practice Address - Street 1:1145 S MORLEY ST
Practice Address - Street 2:STE 5
Practice Address - City:MOBERLY
Practice Address - State:MO
Practice Address - Zip Code:65270-1948
Practice Address - Country:US
Practice Address - Phone:660-263-3185
Practice Address - Fax:660-263-7271
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:CONLEY CLINIC, LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-08-28
Last Update Date:2012-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MOR7880207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO243532242Medicaid
MO243532242Medicaid
MO14827Medicare PIN