Basic Information
| Provider Information | |||||||||
| NPI: | 1003898495 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | PARKS | ||||||||
| FirstName: | JOSEPH | ||||||||
| MiddleName: | J. | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | FAMILY HEALTH CENTER OF BOONE COUNTY | ||||||||
| Address2: | 1001 WEST WORLEY | ||||||||
| City: | COLUMBIA | ||||||||
| State: | MO | ||||||||
| PostalCode: | 352032037 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5732142314 | ||||||||
| FaxNumber: | 5738142784 | ||||||||
| Practice Location | |||||||||
| Address1: | FAMILY HEALTH CENTER OF BOONE COUNTY | ||||||||
| Address2: | 1001 WEST WORLEY | ||||||||
| City: | COLUMBIA | ||||||||
| State: | MO | ||||||||
| PostalCode: | 352032037 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5732142314 | ||||||||
| FaxNumber: | 5738142784 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/19/2005 | ||||||||
| LastUpdateDate: | 02/24/2022 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 02/24/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2084P0800X | 102804 | MO | N | Allopathic & Osteopathic Physicians | Psychiatry & Neurology | Psychiatry | 208D00000X | 64665 | TN | Y | Allopathic & Osteopathic Physicians | General Practice |
ID Information
| ID | Type | State | Issuer | Description | 206741324 | 05 | MO | MEDICAID | 1003898495 | 01 | MO | NPI NUMBER | OTHER |