Provider Demographics
NPI:1679541783
Name:MACE, JOANN (MD)
Entity type:Individual
Prefix:
First Name:JOANN
Middle Name:
Last Name:MACE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:1432 SOUTHWEST BLVD
Mailing Address - Street 2:CAPITAL REGION REHABILITATION SPECIALISTS
Mailing Address - City:JEFFERSON CITY
Mailing Address - State:MO
Mailing Address - Zip Code:65109
Mailing Address - Country:US
Mailing Address - Phone:573-632-5660
Mailing Address - Fax:573-632-5859
Practice Address - Street 1:1432 SOUTHWEST BLVD
Practice Address - Street 2:
Practice Address - City:JEFFERSON CITY
Practice Address - State:MO
Practice Address - Zip Code:65109
Practice Address - Country:US
Practice Address - Phone:573-632-5660
Practice Address - Fax:573-632-5859
Is Sole Proprietor?:No
Enumeration Date:2006-03-14
Last Update Date:2009-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2000169335208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
001013325OtherMEDICARE
250012149OtherRR MEDICARE
441613OtherHEALTHLINK
MO205096803Medicaid
6033757OtherCIGNA
131574OtherBLUE CROSS BLUE SHIELD
1860598OtherFIRST HEALTH
E55013OtherMERCY
E55013OtherMERCY
441613OtherHEALTHLINK