| Southern Missouri Internal Medicine, Pc | |
|
3260 Lexington Ave Cape Girardeau MO 63701-2609 | |
| (573) 335-5057 | |
| (573) 335-1552 |
| Full Name | Southern Missouri Internal Medicine, Pc |
|---|---|
| Speciality | Internal Medicine |
| Location | 3260 Lexington Ave, Cape Girardeau, Missouri |
| Authorized Official Name and Position | Mark Jeffery Mcnabb (OWNER) |
| Authorized Official Contact | 5733355057 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Southern Missouri Internal Medicine, Pc 3260 Lexington Ave Cape Girardeau MO 63701-2609 Ph: (573) 335-5057 | Southern Missouri Internal Medicine, Pc 3260 Lexington Ave Cape Girardeau MO 63701-2609 Ph: (573) 335-5057 |
| NPI Number | 1750625844 |
|---|---|
| Provider Enumeration Date | 11/15/2012 |
| Last Update Date | 11/15/2012 |
| Medicare PECOS PAC ID | 1254583057 |
|---|---|
| Medicare Enrollment ID | O20121130000026 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1750625844 | NPI | - | NPPES |
| 203716006 | Medicaid | MO |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207R00000X | Internal Medicine | DO100129 (Missouri) | Primary |
| Provider Name | Mark Jeffery Mcnabb |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1942337522 PECOS PAC ID: 7012829724 Enrollment ID: I20031103000071 |
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