| Organization Name: | PREVENTIVE HEALTHCARE |
| NPI Number: | 1194019521 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | BRENT K CAUDILL (OWNER/DOCTOR) |
| Mailing Address: | 201 N Jefferson St Suite D Saint James |
| State: | MO US |
| Postal Code: | 655591919 |
| Phone Number: | 5732650911 |
| Fax Number: | 5732650912 |
| NPI Enumeration Date: | 06/02/2011 |
| NPI Last Update Date: | 09/01/2011 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 261QP2300X |
| License Number: | 109789 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | MO |
| Taxonomy Type: | Ambulatory Health Care Facilities |
| Taxonomy Classification: | Clinic/Center |
| Taxonomy Specialization: | Primary Care |
| Taxonomy Definition: | |