| Boulware Medical Clinic L.l.c. | |
|
1131 W Kansas St Liberty MO 64068-2281 | |
| (816) 792-5577 | |
| (816) 792-5141 |
| Full Name | Boulware Medical Clinic L.l.c. |
|---|---|
| Speciality | Internal Medicine |
| Location | 1131 W Kansas St, Liberty, Missouri |
| Authorized Official Name and Position | Robert J Boulware (DR.) |
| Authorized Official Contact | 8167925577 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Boulware Medical Clinic L.l.c. 1131 W Kansas St Liberty MO 64068-2281 Ph: (816) 792-5577 | Boulware Medical Clinic L.l.c. 1131 W Kansas St Liberty MO 64068-2281 Ph: (816) 792-5577 |
| NPI Number | 1548462799 |
|---|---|
| Provider Enumeration Date | 06/01/2007 |
| Last Update Date | 07/27/2007 |
| Medicare PECOS PAC ID | 6406840081 |
|---|---|
| Medicare Enrollment ID | O20040414001473 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1548462799 | NPI | - | NPPES |
| 19532014 | Other | MO | BLUE CROSS GROUP |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207R00000X | Internal Medicine | (Missouri) | Primary |
| Provider Name | Robert J Boulware |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1801978259 PECOS PAC ID: 9335133586 Enrollment ID: I20040415001199 |
| Provider Name | William T Boulware |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1023190493 PECOS PAC ID: 4981698123 Enrollment ID: I20040415001305 |
| Provider Name | Mary C Dugan |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1043343346 PECOS PAC ID: 3870653553 Enrollment ID: I20081125000770 |
| Provider Name | Grace N Llewellyn |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1972068674 PECOS PAC ID: 1658610811 Enrollment ID: I20190305002804 |
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