1780776807 NPI number — NEUROPSYCHOLOGICAL ASSOCIATES OF SOUTHWEST MISSOURI, P.C.

Table of content: (NPI 1780776807)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1780776807 NPI number — NEUROPSYCHOLOGICAL ASSOCIATES OF SOUTHWEST MISSOURI, P.C.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
NEUROPSYCHOLOGICAL ASSOCIATES OF SOUTHWEST MISSOURI, P.C.
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:
1780776807
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
07/21/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
4350 S NATIONAL AVE
Provider Second Line Business Mailing Address:
SUITE B116
Provider Business Mailing Address City Name:
SPRINGFIELD
Provider Business Mailing Address State Name:
MO
Provider Business Mailing Address Postal Code:
65810-2658
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
417-881-1810
Provider Business Mailing Address Fax Number:
417-881-1866

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
4350 S NATIONAL AVE STE B116
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:
65810-2658
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
417-881-1810
Provider Business Practice Location Address Fax Number:
417-881-1866
Provider Enumeration Date:
09/28/2006

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
HOOD
Authorized Official First Name:
ROBIN
Authorized Official Middle Name:
RENEE
Authorized Official Title or Position:
OFFICE MANAGER
Authorized Official Telephone Number:
417-881-1810

Provider Taxonomy Codes

  • Taxonomy code: 101YP2500X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 103G00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 103TC0700X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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