| Mary M. Dick, Md Llc | |
|
2100 E Broadway Suite 325 Columbia MO 65201-6082 | |
| (573) 449-5800 | |
| (573) 693-4190 |
| Full Name | Mary M. Dick, Md Llc |
|---|---|
| Speciality | Clinic/center - Adult Mental Health |
| Location | 2100 E Broadway, Columbia, Missouri |
| Authorized Official Name and Position | Mary Margaret Dick (OWNER) |
| Authorized Official Contact | 5734495800 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Mary M. Dick, Md Llc 2100 E Broadway Suite 325 Columbia MO 65201-6082 Ph: (573) 449-5800 | Mary M. Dick, Md Llc 2100 E Broadway Suite 325 Columbia MO 65201-6082 Ph: (573) 449-5800 |
| NPI Number | 1396001723 |
|---|---|
| Provider Enumeration Date | 04/10/2012 |
| Last Update Date | 04/10/2012 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1396001723 | NPI | - | NPPES |
| 309074 | Other | MO | COVENTRY HEALTH CARE PLAN |
| 12382 | Other | MO | ANTHEM BLUE CROSS BLUE SHIELD |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QM0850X | Clinic/center - Adult Mental Health | R8178 (Missouri) | Primary |
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