1780848747 NPI number — MONITEAU MENTAL HEALTH CARE

Table of content: (NPI 1780848747)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1780848747 NPI number — MONITEAU MENTAL HEALTH CARE

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
MONITEAU MENTAL HEALTH CARE
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:
1780848747
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
07/17/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 5111
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:
65801-5111
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
417-429-2180
Provider Business Mailing Address Fax Number:
417-832-9799

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
320 S OAK ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CALIFORNIA
Provider Business Practice Location Address State Name:
MO
Provider Business Practice Location Address Postal Code:
65018-1824
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
573-230-1037
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
07/17/2008

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
SHUCK
Authorized Official First Name:
KELLIE
Authorized Official Middle Name:
L
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
573-796-2905

Provider Taxonomy Codes

  • Taxonomy code: 364SP0808X , with the licence number:  2000161947 , 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: 427531801 , issued by the state of ( MO ) . This identifiers is of the category "MEDICAID".