Basic Information
Provider Information
NPI: 1528272630
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: SPEICHINGER
FirstName: ELLA
MiddleName: DOMINIQUE
NamePrefix:  
NameSuffix:  
Credential: M.D.
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: PO BOX 843966
Address2:  
City: KANSAS CITY
State: MO
PostalCode: 641843966
CountryCode: US
TelephoneNumber: 5738823300
FaxNumber: 5738840943
Practice Location
Address1: 404 N KEENE ST
Address2:  
City: COLUMBIA
State: MO
PostalCode: 652016626
CountryCode: US
TelephoneNumber: 5734996084
FaxNumber: 5734996088
Other Information
ProviderEnumerationDate: 05/09/2007
LastUpdateDate: 02/21/2018
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: Y
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
207V00000X2017024866MOY Allopathic & Osteopathic PhysiciansObstetrics & Gynecology 
207V00000XA95651CAN Allopathic & Osteopathic PhysiciansObstetrics & Gynecology 

No ID Information.


Home