MEDICARE: CATHOLIC CHARITIES OF SOUTHERN MISSOURI FOR CAPE COUNTY

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	251B00000X	Case Management Agency		MO

General Provider Information

NPI Number	:	1396148078
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CATHOLIC CHARITIES OF SOUTHERN MISSOURI FOR CAPE COUNTY

Provider Business Mailing Address
First Line	:	424 E MONASTERY ST
Second Line	:
City	:	SPRINGFIELD
State	:	MO
Zip	:	65807-6099
Country	:	US
Telephone Number	:	417-720-4213
Fax Number	:	417-720-4216

Provider Business Practice Location Address
First Line	:	231 N MAIN ST
Second Line	:
City	:	CAPE GIRARDEAU
State	:	MO
Zip	:	63701-7221
Country	:	US
Telephone Number	:	573-335-0905
Fax Number	:	573-335-0988

Authorized Official
Title or Position	:	SENIOR VP OPERATIONS
Name	:	JOHN LUNARDINI
Credential	:
Telephone Number	:	417-720-4213

Provider Enumeration Date	:	10/08/2014
Last Update Date	:	04/28/2020

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