| Southwest Gastroenterology, Llc | |
|
2817 Mc Clelland Blvd Suite 153 Joplin MO 64804-1629 | |
| (417) 206-4928 | |
| (417) 206-4734 |
| Full Name | Southwest Gastroenterology, Llc |
|---|---|
| Speciality | Internal Medicine - Gastroenterology |
| Location | 2817 Mc Clelland Blvd, Joplin, Missouri |
| Authorized Official Name and Position | Xujun Wu (PRESIDENT) |
| Authorized Official Contact | 3304093337 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Southwest Gastroenterology, Llc 2817 Mc Clelland Blvd Suite 153 Joplin MO 64804-1629 Ph: (417) 206-4928 | Southwest Gastroenterology, Llc 2817 Mc Clelland Blvd Suite 153 Joplin MO 64804-1629 Ph: (417) 206-4928 |
| NPI Number | 1679686182 |
|---|---|
| Provider Enumeration Date | 08/17/2006 |
| Last Update Date | 08/22/2020 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1679686182 | NPI | - | NPPES |
| 2006024391 | Other | MO | STATE OF MO LICENSE |
| 2514363 | Medicaid | OH |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207RG0100X | Internal Medicine - Gastroenterology | 2006024391 (Missouri) | Primary |
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