1134128721 NPI number — ELK RIVER HEALTH SERVICES, INC.

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1134128721 NPI number — ELK RIVER HEALTH SERVICES, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ELK RIVER HEALTH SERVICES, INC.
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
6
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1134128721
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/15/2014
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 750
Provider Second Line Business Mailing Address:
104 E MAIN STREET
Provider Business Mailing Address City Name:
ANDERSON
Provider Business Mailing Address State Name:
MO
Provider Business Mailing Address Postal Code:
64831-0750
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
417-845-6984
Provider Business Mailing Address Fax Number:
417-845-6976

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
104 E MAIN STREET
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ANDERSON
Provider Business Practice Location Address State Name:
MO
Provider Business Practice Location Address Postal Code:
64831-0750
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
417-845-6984
Provider Business Practice Location Address Fax Number:
417-845-6976
Provider Enumeration Date:
07/18/2005

Additional Information

Authorized Official

Authorized Official Last Name:
PLUMLEE
Authorized Official First Name:
VICKI
Authorized Official Middle Name:
Authorized Official Title or Position:
DIRECTOR
Authorized Official Telephone Number:
417-845-6984

Provider Taxonomy Codes

  • Taxonomy code: 261QR1300X , registered in the state of MO ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 507681385 , issued by the state of ( MO ) . This identifiers is of the category "MEDICAID".
  • Identifier: 596813816 , issued by the state of ( MO ) . This identifiers is of the category "MEDICAID".




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