| Southwest Missouri Infectious Disease Llc | |
|
2872 S Forrest Heights Ave Springfield MO 65809-3417 | |
| (417) 459-1711 | |
| Not Available |
| Full Name | Southwest Missouri Infectious Disease Llc |
|---|---|
| Speciality | Internal Medicine - Infectious Disease |
| Location | 2872 S Forrest Heights Ave, Springfield, Missouri |
| Authorized Official Name and Position | Eric Jerome Fulnecky (OWNER) |
| Authorized Official Contact | 4174591711 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Southwest Missouri Infectious Disease Llc 2872 S Forrest Heights Ave Springfield MO 65809-3417 Ph: (417) 459-1711 | Southwest Missouri Infectious Disease Llc 2872 S Forrest Heights Ave Springfield MO 65809-3417 Ph: (417) 459-1711 |
| NPI Number | 1396284303 |
|---|---|
| Provider Enumeration Date | 02/23/2017 |
| Last Update Date | 02/23/2017 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1396284303 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207RI0200X | Internal Medicine - Infectious Disease | 2004006990 (Missouri) | Primary |
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