| Northwest Missouri State | |
|
800 University Drive Maryville MO 64468 | |
| (660) 562-1313 | |
| Not Available |
| Full Name | Northwest Missouri State |
|---|---|
| Speciality | Family Medicine |
| Location | 800 University Drive, Maryville, Missouri |
| Authorized Official Name and Position | Matthew Cannella (HEAD ATHLETIC TRAINER) |
| Authorized Official Contact | 6605621313 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Northwest Missouri State 800 University Drive Maryville MO 64468 Ph: (660) 562-1313 | Northwest Missouri State 800 University Drive Maryville MO 64468 Ph: (660) 562-1313 |
| NPI Number | 1225310204 |
|---|---|
| Provider Enumeration Date | 09/15/2011 |
| Last Update Date | 02/21/2022 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1225310204 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | (* (Not Available)) | Primary |
| 2255A2300X | Specialist/technologist - Athletic Trainer | (* (Not Available)) | Secondary |
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