1417625963 NPI number — PREFERRED FAMILY HEALTHCARE, INC.

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1417625963 NPI number — PREFERRED FAMILY HEALTHCARE, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
PREFERRED FAMILY HEALTHCARE, 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:
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:
1417625963
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
06/30/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1601 OLD SOUTH RIVER RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SAINT CHARLES
Provider Business Mailing Address State Name:
MO
Provider Business Mailing Address Postal Code:
63303-4120
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
636-224-1210
Provider Business Mailing Address Fax Number:
636-246-1008

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2004B N BALTIMORE ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
KIRKSVILLE
Provider Business Practice Location Address State Name:
MO
Provider Business Practice Location Address Postal Code:
63501-5107
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
417-869-8911
Provider Business Practice Location Address Fax Number:
417-281-3602
Provider Enumeration Date:
08/31/2021

Additional Information

Authorized Official

Authorized Official Last Name:
CONOVER
Authorized Official First Name:
MARK
Authorized Official Middle Name:
Authorized Official Title or Position:
CHIEF REVENUE OFFICER
Authorized Official Telephone Number:
573-603-1460

Provider Taxonomy Codes

  • Taxonomy code: 103K00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 235Z00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

Other Provider's Identifiers (legacy, non-NPI)





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