1386774412 NPI number — AREA COMMUNITY HEALTH EMISSARIES, INC.

Table of content: (NPI 1386774412)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1386774412 NPI number — AREA COMMUNITY HEALTH EMISSARIES, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
AREA COMMUNITY HEALTH EMISSARIES, 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:
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:
1386774412
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
06/21/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 1136
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ANDERSON
Provider Business Mailing Address State Name:
MO
Provider Business Mailing Address Postal Code:
64831-1136
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
417-845-2243
Provider Business Mailing Address Fax Number:
417-845-2533

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
508 W 76 HWY
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ANDERSON
Provider Business Practice Location Address State Name:
MO
Provider Business Practice Location Address Postal Code:
64831
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
417-845-2243
Provider Business Practice Location Address Fax Number:
417-845-2533
Provider Enumeration Date:
03/07/2007

Additional Information

Authorized Official

Authorized Official Last Name:
JAY
Authorized Official First Name:
PHYLLIS
Authorized Official Middle Name:
C
Authorized Official Title or Position:
GRANT MANAGER
Authorized Official Telephone Number:
417-845-2243

Provider Taxonomy Codes

  • Taxonomy code: 1223D0001X , with the licence number:  110 , 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)

  • Identifier: 749331708 , issued by the state of ( MO ) . This identifiers is of the category "MEDICAID".
  • Identifier: 748308707 , issued by the state of ( MO ) . This identifiers is of the category "MEDICAID".
  • Identifier: 407479906 , issued by the state of ( MO ) . This identifiers is of the category "MEDICAID".
  • Identifier: 401467311 , issued by the state of ( MO ) . This identifiers is of the category "MEDICAID".
  • Identifier: 401786215 , issued by the state of ( MO ) . This identifiers is of the category "MEDICAID".




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