| Renova Medical Center, Llc | |
|
1401 Forum Blvd Ste 101 Columbia MO 65203-1915 | |
| (573) 228-0217 | |
| (573) 234-1368 |
| Full Name | Renova Medical Center, Llc |
|---|---|
| Speciality | General Practice |
| Location | 1401 Forum Blvd Ste 101, Columbia, Missouri |
| Authorized Official Name and Position | Kerrie J Rose (OWNER) |
| Authorized Official Contact | 5732280217 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Renova Medical Center, Llc 1401 Forum Blvd Ste 101 Columbia MO 65203-1915 Ph: (573) 228-0217 | Renova Medical Center, Llc 1401 Forum Blvd Ste 101 Columbia MO 65203-1915 Ph: (573) 228-0217 |
| NPI Number | 1447741681 |
|---|---|
| Provider Enumeration Date | 05/23/2018 |
| Last Update Date | 05/23/2018 |
| Medicare PECOS PAC ID | 3577811736 |
|---|---|
| Medicare Enrollment ID | O20180803000612 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1447741681 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 208D00000X | General Practice | (* (Not Available)) | Primary |
| Provider Name | Joni C Ahern |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1033570205 PECOS PAC ID: 9133418072 Enrollment ID: I20160517001744 |
| Provider Name | Shane Michael Holloway |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1821534231 PECOS PAC ID: 2163706649 Enrollment ID: I20170228002548 |
| Provider Name | Robert Calaluce |
|---|---|
| Provider Type | Practitioner - General Practice |
| Provider Identifiers | NPI Number: 1235648551 PECOS PAC ID: 9739437997 Enrollment ID: I20180803000708 |
| Provider Name | Rachael Goodman |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1013569151 PECOS PAC ID: 9931522281 Enrollment ID: I20200706002042 |
| Provider Name | Anthony Joseph Breen |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1407567068 PECOS PAC ID: 1850760695 Enrollment ID: I20221216002290 |
Columbia Family Medical Group, Inc Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 303 N Keene St, Suite 301, Columbia, MO 65201 Phone: 573-449-0808 Fax: 573-442-1331 | |
Sme Virginia Pc Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 5728 Pergola Dr Apt 207, Columbia, MO 65201 Phone: 678-977-5507 | |
University Physicians Specialty Care Associates Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 3100 W Broadway, Columbia, MO 65203 Phone: 573-884-7701 | |
Sme Utah, P.c. Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 5728 Pergola Dr Apt 207, Columbia, MO 65201 Phone: 678-977-5507 | |
Sme Idaho P.c. Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 5728 Pergola Dr Apt 207, Columbia, MO 65201 Phone: 678-977-5507 | |
Nephrology And Hypertension Associates Primary Care Clinic Medicare: Medicare Enrolled Practice Location: 1205 W Broadway, Columbia, MO 65203 Phone: 573-499-0642 Fax: 573-449-1787 | |
Family Dental Center Columbia East Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 2475 Broadway Bluffs Dr, Suite 200, Columbia, MO 65201 Phone: 573-777-9282 Fax: 573-777-9569 |