Basic Information
| Provider Information | |||||||||
| NPI: | 1629459045 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | KIRCHHOFF | ||||||||
| FirstName: | SARAH | ||||||||
| MiddleName: | NICOLE | ||||||||
| NamePrefix: | |||||||||
| NameSuffix: | |||||||||
| Credential: | MD | ||||||||
| OtherOrganizationName: | |||||||||
| OtherOrganizationType: | |||||||||
| OtherLastName: | KAPLA | ||||||||
| OtherFirstName: | SARAH | ||||||||
| OtherMiddleName: | NICOLE | ||||||||
| OtherNamePrefix: | |||||||||
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| OtherCredential: | MD | ||||||||
| OtherLastNameType: | 1 | ||||||||
| Mailing Information | |||||||||
| Address1: | 1 HOSPITAL DR | ||||||||
| Address2: | MA303, DC032.00 | ||||||||
| City: | COLUMBIA | ||||||||
| State: | MO | ||||||||
| PostalCode: | 652121000 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5738842912 | ||||||||
| FaxNumber: | 5738844122 | ||||||||
| Practice Location | |||||||||
| Address1: | 905 S MAIN ST | ||||||||
| Address2: | |||||||||
| City: | CONCORDIA | ||||||||
| State: | MO | ||||||||
| PostalCode: | 640208335 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6604637966 | ||||||||
| FaxNumber: | 6604637729 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/11/2015 | ||||||||
| LastUpdateDate: | 10/15/2018 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | 2018017439 | MO | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Family Medicine |
ID Information
| ID | Type | State | Issuer | Description | 200029995 | 05 | MO | MEDICAID |