Unknown Individual – Obstetrics & Gynecology Physician, NPI 1124008479

Unknown Individual is a healthcare provider. based in Rolla, Missouri. specializing in Obstetrics & Gynecology Physician. They hold a License No. 2005037955 (MO). The NPI Number for Unknown Individual is 1124008479

Main info

Organization
Inactive
Name
Unknown Individual
NPI
1124008479
Phone
(573) 426-6588
Address
604B W 6TH ST
Deactivation Date
17 October 2022
Data current as of
19 May 2026

Profile Insights

NPPES metrics only — not quality of care.

Methodology
Experience14
Completeness75
Years active:0State licenses:1Digital endpointsOther names

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Provider Addresses for Unknown Individual

  • West 6th Street, Rolla, Phelps County, Missouri, 65409, United States

    ROLLA, MO 654012941

    Phone: (573) 426-6588

    Fax: (573) 426-5664

    Mailing address matches the actual address.

NPPES updates history

No NPPES updates recorded for this provider.

Prescription Activity

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Open Payments (CMS)

No Open Payments data available for this provider.

This can happen when there are no reportable CMS Open Payments records.

Medicare Enrollment & Revalidation

Source: CMS public data · Not endorsed by CMS ·

Educational use only—not medical, billing, or legal advice.

No Medicare enrollment or revalidation data available for this provider in our database.

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Medicare Utilization (FFS)

Source: CMS public data · Not endorsed by CMS · Beneficiary counts under 11 are suppressed in source data ·

Educational use only—not medical, billing, or legal advice.

No Medicare fee-for-service utilization data available for this provider in our database.

Insurance plans in this area (ZIP 65401)

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Reviews

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Frequently asked questions

What is Unknown Individual's NPI number?
Unknown Individual's NPI is 1124008479 — the number used across U.S. healthcare to identify this provider.
Is Unknown Individual still active if the NPI shows inactive?
NPPES shows Unknown Individual as inactive; dates on the record explain the timeline when available.
What clinical focus is listed for Unknown Individual?
At a glance, Unknown Individual is tied to Obstetrics & Gynecology Physician. Clinical services aligned with this taxonomy classification.
What locale is associated with Unknown Individual?
Directory geography for Unknown Individual centers on Rolla, Missouri.
Can I trust this NPI listing for Unknown Individual?
The listing is sourced from the national NPI registry. If something looks off, compare with NPPES and the clinic's website.

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