Basic Information
| Provider Information | |||||||||
| NPI: | 1831141837 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | VIENNA HEALTH CARE | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 715 | ||||||||
| Address2: | |||||||||
| City: | VIENNA | ||||||||
| State: | MO | ||||||||
| PostalCode: | 655820715 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5734223636 | ||||||||
| FaxNumber: | 5734223434 | ||||||||
| Practice Location | |||||||||
| Address1: | 606 HIGHWAY 63 S | ||||||||
| Address2: | |||||||||
| City: | VIENNA | ||||||||
| State: | MO | ||||||||
| PostalCode: | 655828101 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5734223636 | ||||||||
| FaxNumber: | 5734223434 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/17/2006 | ||||||||
| LastUpdateDate: | 08/22/2020 | ||||||||
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| AuthorizedOfficialLastName: | BOHLMANN | ||||||||
| AuthorizedOfficialFirstName: | KIMBERLY | ||||||||
| AuthorizedOfficialMiddleName: | DENIESE | ||||||||
| AuthorizedOfficialTitleorPosition: | PHYSICAN | ||||||||
| AuthorizedOfficialTelephone: | 5734223636 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | M.D. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | 2006002908 | MO | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Family Medicine |
No ID Information.