1366867491 NPI number — SPECIAL CARE VISION OF MISSOURI, LLC

Table of content: PAIGE LENE'E MERCER LMSW (NPI 1407339724)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1366867491 NPI number — SPECIAL CARE VISION OF MISSOURI, LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
SPECIAL CARE VISION OF MISSOURI, 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:
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:
1366867491
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/04/2014
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
12910 SHELBYVILLE RD
Provider Second Line Business Mailing Address:
300
Provider Business Mailing Address City Name:
LOUISVILLE
Provider Business Mailing Address State Name:
KY
Provider Business Mailing Address Postal Code:
40243-1593
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
502-244-2457
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1115 WASHINGTON ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CHILLICOTHEE
Provider Business Practice Location Address State Name:
MO
Provider Business Practice Location Address Postal Code:
64601-1306
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
502-244-2457
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
02/26/2014

Additional Information

Authorized Official

Authorized Official Last Name:
VELTEN
Authorized Official First Name:
JESSICA
Authorized Official Middle Name:
Authorized Official Title or Position:
DIRECTOR OF BILLING
Authorized Official Telephone Number:
502-244-2457

Provider Taxonomy Codes

  • Taxonomy code: 152W00000X , with the licence number:  T02343 , 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)





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