| Nathan Lee Granneman, MD | |
| 401 N Keene St, Columbia, MO 65201-6625 | |
| (573) 876-1600 | |
| (573) 876-1606 | 
| Full Name | Nathan Lee Granneman | 
|---|---|
| Gender | Male | 
| Speciality | Preventive Medicine - Occupational Medicine | 
| Location | 401 N Keene St, Columbia, Missouri | 
| Accepts Medicare Assignments | Medicare enrolled and may accept medicare through third-party reassignment. May prescribe medicare part D drugs. | 
| Identifier | Type | State | Issuer | 
|---|---|---|---|
| 1689960171 | NPI | - | NPPES | 
| 200008322 | Medicaid | MO | 
| Taxonomy | Type | License (State) | Status | 
|---|---|---|---|
| 2083X0100X | Preventive Medicine - Occupational Medicine | 2012023532 (Missouri) | Primary | 
| 207QS0010X | Family Medicine - Sports Medicine | 2012023532 (Missouri) | Secondary | 
| Entity Name | Boone Physician Services Llc | 
|---|---|
| Entity Type | Part B Supplier - Clinic/group Practice | 
| Entity Identifiers | NPI Number: 1760893259 PECOS PAC ID: 6507090644 Enrollment ID: O20131003000535 | 
| Mailing Address | Practice Location Address | 
|---|---|
| Nathan Lee Granneman, MD 401 N Keene St, Columbia, MO 65201-6625 Ph: (573) 876-1600 | Nathan Lee Granneman, MD 401 N Keene St, Columbia, MO 65201-6625 Ph: (573) 876-1600 | 
| Dr. Janie Rhea Vale,  Preventive Medicine Medicare: Not Enrolled in Medicare Practice Location: 1012 Bourn Ave, Columbia, MO 65203 Phone: 573-446-2993 | |
| Dr. Eddie Wayne Runde, M.D. Preventive Medicine Medicare: Medicare Enrolled Practice Location: One Hospital Dr, Columbia, MO 65212 Phone: 573-882-8091 Fax: 573-884-5994 | |
| Michael Szewczyk, M.D. Preventive Medicine Medicare: Not Enrolled in Medicare Practice Location: 1701 E Broadway, Suite 204, Columbia, MO 65201 Phone: 573-815-2667 | |
| Dr. Richard W Stahlhut, MD Preventive Medicine Medicare: Not Enrolled in Medicare Practice Location: 194 W Green Meadows Rd, Columbia, MO 65203 Phone: 585-752-8883 | |
| Dr. Robert F Thomas, MD Preventive Medicine Medicare: Not Enrolled in Medicare Practice Location: 3700 I 70 Dr Se, Suite 106, Columbia, MO 65201 Phone: 573-256-7637 Fax: 573-817-3103 | |
| Dr. Osman Amin, DO Preventive Medicine Medicare: Medicare Enrolled Practice Location: 2003 W Broadway, Columbia, MO 65203 Phone: 573-256-7637 Fax: 573-817-3103 | |
| Chris Perrin, MS, ATC Preventive Medicine Medicare: Not Enrolled in Medicare Practice Location: 1 Champions Drive Suite 230, Columbia, MO 65211 Phone: 573-882-3532 |