Organization Name: | CENTRAL MISSOURI HEALTHCARE ASSOCIATES, LLC |
NPI Number: | 1164790465 |
Entity Type Code: | Organizational (2) |
Authorized Official Name: | KATHLEEN LENZ (PRESIDENT) |
Mailing Address: | 1417 Bingham Rd Boonville |
State: | MO US |
Postal Code: | 652332229 |
Phone Number: | 6608828018 |
Fax Number: | 6608823188 |
NPI Enumeration Date: | 12/01/2011 |
NPI Last Update Date: | 09/05/2012 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 363LF0000X |
License Number: | 116825 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | MO |
Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
Taxonomy Classification: | Nurse Practitioner |
Taxonomy Specialization: | Family |
Taxonomy Definition: |