Provider Demographics
NPI:1932322872
Name:MURPHY MEDICAL, INC.
Entity Type:Organization
Organization Name:MURPHY MEDICAL, INC.
Other - Org Name:DR. RENEE J. CLAYCAMP
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:RENEE
Authorized Official - Middle Name:J
Authorized Official - Last Name:CLAYCAMP
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:816-632-1799
Mailing Address - Street 1:215 S WALNUT ST
Mailing Address - Street 2:
Mailing Address - City:CAMERON
Mailing Address - State:MO
Mailing Address - Zip Code:64429-2265
Mailing Address - Country:US
Mailing Address - Phone:816-632-1799
Mailing Address - Fax:816-632-5688
Practice Address - Street 1:215 S WALNUT ST
Practice Address - Street 2:
Practice Address - City:CAMERON
Practice Address - State:MO
Practice Address - Zip Code:64429-2265
Practice Address - Country:US
Practice Address - Phone:816-632-1799
Practice Address - Fax:816-632-5688
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-10
Last Update Date:2010-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO113134305R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes305R00000XManaged Care OrganizationsPreferred Provider Organization
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO500597406Medicaid
MOJ830000Medicare ID - Type UnspecifiedMEDICARE
MO500597406Medicaid