| Missouri Obesity Center,llc | |
|
1601 E Broadway Ste 160 Columbia MO 65201-5821 | |
| (573) 777-9917 | |
| (573) 777-9918 |
| Full Name | Missouri Obesity Center,llc |
|---|---|
| Speciality | Internal Medicine |
| Location | 1601 E Broadway Ste 160, Columbia, Missouri |
| Authorized Official Name and Position | Charles Kontor Wiredu (OWNER) |
| Authorized Official Contact | 4179885306 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Missouri Obesity Center,llc 5102 Beacon Falls Dr Columbia MO 65203-9056 Ph: (417) 988-5306 | Missouri Obesity Center,llc 1601 E Broadway Ste 160 Columbia MO 65201-5821 Ph: (573) 777-9917 |
| NPI Number | 1811467053 |
|---|---|
| Provider Enumeration Date | 11/30/2018 |
| Last Update Date | 11/30/2018 |
| Medicare PECOS PAC ID | 0749526275 |
|---|---|
| Medicare Enrollment ID | O20190103003220 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1811467053 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207RE0101X | Internal Medicine - Endocrinology, Diabetes & Metabolism | (* (Not Available)) | Primary |
| Provider Name | Charles K Wiredu |
|---|---|
| Provider Type | Practitioner - Hospitalist |
| Provider Identifiers | NPI Number: 1114117892 PECOS PAC ID: 7214024074 Enrollment ID: I20090721000447 |
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