Provider Demographics
NPI:1952749988
Name:BRAIN AND NEUROSPINE CLINIC OF MISSOURI
Entity Type:Organization
Organization Name:BRAIN AND NEUROSPINE CLINIC OF MISSOURI
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:ANGIE
Authorized Official - Middle Name:
Authorized Official - Last Name:KAPP
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:573-331-3951
Mailing Address - Street 1:PO BOX 693
Mailing Address - Street 2:
Mailing Address - City:CAPE GIRARDEAU
Mailing Address - State:MO
Mailing Address - Zip Code:63702-0693
Mailing Address - Country:US
Mailing Address - Phone:573-331-3953
Mailing Address - Fax:573-331-3952
Practice Address - Street 1:3250 GORDONVILLE RD
Practice Address - Street 2:
Practice Address - City:CAPE GIRARDEAU
Practice Address - State:MO
Practice Address - Zip Code:63703-5056
Practice Address - Country:US
Practice Address - Phone:573-331-3951
Practice Address - Fax:573-331-3953
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-06-12
Last Update Date:2013-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO10441174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty