1548394166 NPI number — PEACH WOOD MANOR RCF

Table of content: DR. CYNTHIA ELAINE BENNETT M.D. (NPI 1063491199)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1548394166 NPI number — PEACH WOOD MANOR RCF

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
PEACH WOOD MANOR RCF
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:
1548394166
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
07/21/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
HC 81
Provider Second Line Business Mailing Address:
BOX 8240
Provider Business Mailing Address City Name:
CASSVILLE
Provider Business Mailing Address State Name:
MO
Provider Business Mailing Address Postal Code:
65625
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
417-847-3902
Provider Business Mailing Address Fax Number:
417-847-0052

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
HIGHWAY 12
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CASSVILLE
Provider Business Practice Location Address State Name:
MO
Provider Business Practice Location Address Postal Code:
65625
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
417-847-3902
Provider Business Practice Location Address Fax Number:
417-847-0052
Provider Enumeration Date:
03/15/2007

Additional Information

Authorized Official

Authorized Official Last Name:
DACY
Authorized Official First Name:
LYNDA
Authorized Official Middle Name:
GAIL
Authorized Official Title or Position:
CO-OWNER
Authorized Official Telephone Number:
417-847-3902

Provider Taxonomy Codes

  • Taxonomy code: 311ZA0620X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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