1174529739 NPI number — MISSOURI VEIN CARE, LLC

Table of content: RACHEL LORRAINE KNOBLICH DNP, APRN, CNP (NPI 1306639919)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1174529739 NPI number — MISSOURI VEIN CARE, LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
MISSOURI VEIN CARE, LLC
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:
1174529739
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
06/15/2026
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1620 SOUTHRIDGE DR STE B
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
JEFFERSON CITY
Provider Business Mailing Address State Name:
MO
Provider Business Mailing Address Postal Code:
65109-4005
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
573-632-2780
Provider Business Mailing Address Fax Number:
573-632-2784

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1620 SOUTHRIDGE DR STE B
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
JEFFERSON CITY
Provider Business Practice Location Address State Name:
MO
Provider Business Practice Location Address Postal Code:
65109-4005
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
573-632-2780
Provider Business Practice Location Address Fax Number:
573-632-2784
Provider Enumeration Date:
06/28/2005

Additional Information

Authorized Official

Authorized Official Last Name:
RYAN
Authorized Official First Name:
MICHAEL
Authorized Official Middle Name:
HUNTER
Authorized Official Title or Position:
OWNER/MEDICAL DOCTOR
Authorized Official Telephone Number:
573-632-2780

Provider Taxonomy Codes

  • Taxonomy code: 202K00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 50-6126507 , issued by the state of ( MO ) . This identifiers is of the category "MEDICAID".




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