| Broadway Internal Medicine Associates L.l.c. | |
|
204 N Keene St Suite 100 Columbia MO 65201-8102 | |
| (573) 442-0320 | |
| (573) 442-0421 |
| Full Name | Broadway Internal Medicine Associates L.l.c. |
|---|---|
| Speciality | Internal Medicine |
| Location | 204 N Keene St, Columbia, Missouri |
| Authorized Official Name and Position | Douglas Eugene Vogt (OWNER/PHYSICIAN) |
| Authorized Official Contact | 5734420320 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Broadway Internal Medicine Associates L.l.c. 204 N Keene St Suite 100 Columbia MO 65201-8102 Ph: (573) 442-0320 | Broadway Internal Medicine Associates L.l.c. 204 N Keene St Suite 100 Columbia MO 65201-8102 Ph: (573) 442-0320 |
| NPI Number | 1336106426 |
|---|---|
| Provider Enumeration Date | 05/01/2006 |
| Last Update Date | 06/25/2014 |
| Medicare PECOS PAC ID | 5193706430 |
|---|---|
| Medicare Enrollment ID | O20040525000222 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1336106426 | NPI | - | NPPES |
| 503817504 | Medicaid | MO |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207R00000X | Internal Medicine | (* (Not Available)) | Primary |
| Provider Name | Douglas E Vogt |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1669430070 PECOS PAC ID: 3971584210 Enrollment ID: I20091203000323 |
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