Provider Demographics
NPI:1902907967
Name:CHRISTINA E. STIXRUD & ASSOCIATES, M.D., P.C.
Entity Type:Organization
Organization Name:CHRISTINA E. STIXRUD & ASSOCIATES, M.D., P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:CHRISTINA
Authorized Official - Middle Name:ELAINE
Authorized Official - Last Name:STIXRUD
Authorized Official - Suffix:IV
Authorized Official - Credentials:MD
Authorized Official - Phone:573-441-1000
Mailing Address - Street 1:1701 E BROADWAY
Mailing Address - Street 2:SUITE 203
Mailing Address - City:COLUMBIA
Mailing Address - State:MO
Mailing Address - Zip Code:65201-8018
Mailing Address - Country:US
Mailing Address - Phone:573-441-1000
Mailing Address - Fax:573-441-1010
Practice Address - Street 1:1701 E BROADWAY
Practice Address - Street 2:SUITE 203
Practice Address - City:COLUMBIA
Practice Address - State:MO
Practice Address - Zip Code:65201-8018
Practice Address - Country:US
Practice Address - Phone:573-441-1000
Practice Address - Fax:573-441-1010
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-25
Last Update Date:2009-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2004014283207R00000X, 208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
No208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO500774500Medicaid
MO000014874Medicare ID - Type Unspecified
MOI18906Medicare UPIN