1306394077 NPI number — MSNRC OPS, INC.

Table of content: (NPI 1306394077)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1306394077 NPI number — MSNRC OPS, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
MSNRC OPS, 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:
MAGNOLIA SQUARE NURSING AND REHAB
Provider Other Organization Name Type Code:
3
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:
1306394077
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
12/28/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1502 W EDGEWOOD 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:
65807-3567
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
417-877-7545
Provider Business Mailing Address Fax Number:
417-877-7551

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1502 W EDGEWOOD ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SPRINGFIELD
Provider Business Practice Location Address State Name:
MO
Provider Business Practice Location Address Postal Code:
65807-3567
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
417-877-7545
Provider Business Practice Location Address Fax Number:
417-877-7551
Provider Enumeration Date:
09/12/2016

Additional Information

Authorized Official

Authorized Official Last Name:
ADAMS
Authorized Official First Name:
BRANDON
Authorized Official Middle Name:
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
501-932-0050

Provider Taxonomy Codes

  • Taxonomy code: 314000000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 101491405 , issued by the state of ( MO ) . This identifiers is of the category "MEDICAID".
  • Identifier: 044662 . This is a "FACILITY LICENSE" identifier , issued by the state of ( MO ) . This identifiers is of the category "OTHER".




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