Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.
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Retired

Organization Medical Specialty Clinic/Center · NPI 1962818435

Retired is a Medical Specialty Clinic/Center in Hallsville, Missouri. Licensed in Missouri. Registered with an NPI since 2014.

Licensed in
MO
In the registry since
2014
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Practice location Address checks out

13714 N Sportsmans Dr
Hallsville, MO 65255-9330
Phone: (573) 696-2391
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Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Medical Specialty Clinic/Center (primary) Taxonomy 261QM2500X · Licence R5108 (MO)

Record details

NPI number1962818435
Entity typeOrganization (Type 2)
Organization subpartNo
Authorized official Herb Bastow — Urologist · (573) 696-2391
NPI enumeratedJuly 6, 2014
Last updated in NPPESJuly 6, 2014
Mailing address13714 N Sportsmans Dr, Hallsville, MO 65255-9330