1306124847 NPI number — CATHOLIC CHARITIES OF SOUTHERN MISSOURI

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 1306124847 NPI number — CATHOLIC CHARITIES OF SOUTHERN MISSOURI

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CATHOLIC CHARITIES OF SOUTHERN MISSOURI
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:
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:
1306124847
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
06/22/2021
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
424 E MONASTERY ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SPRINGFIELD
Provider Business Mailing Address State Name:
MO
Provider Business Mailing Address Postal Code:
65807-6099
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
417-720-4213
Provider Business Mailing Address Fax Number:
417-866-1140

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
205 W MALONE AVE STE B
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SIKESTON
Provider Business Practice Location Address State Name:
MO
Provider Business Practice Location Address Postal Code:
63801-2826
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
734-810-6595
Provider Business Practice Location Address Fax Number:
573-481-0695
Provider Enumeration Date:
08/02/2011

Additional Information

Authorized Official

Authorized Official Last Name:
TAYLOR
Authorized Official First Name:
MAURA
Authorized Official Middle Name:
Authorized Official Title or Position:
EXECUTIVE DIRECTOR
Authorized Official Telephone Number:
417-866-0841

Provider Taxonomy Codes

  • Taxonomy code: 251B00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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