Organization Name: | LETASSY HEALTH SERVICES |
NPI Number: | 1780603969 |
Entity Type Code: | Organizational (2) |
Authorized Official Name: | DAVID T LETASSY (RPH) |
Mailing Address: | 1002 W Pine St Poplar Bluff |
State: | MO US |
Postal Code: | 639014840 |
Phone Number: | 5737850048 |
Fax Number: | 5737850459 |
NPI Enumeration Date: | 07/19/2006 |
NPI Last Update Date: | 10/08/2009 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 251K00000X |
License Number: | 854887502 |
Healthcare Provider Taxonomy: (Secondary) | N |
State: | MO |
Taxonomy Type: | Agencies |
Taxonomy Classification: | Public Health or Welfare |
Taxonomy Specialization: | |
Taxonomy Definition: |