MEDICARE: MEDICALODGES, INC.

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	251E00000X	Home Health Agency	032347	MO
2	261QA0600X	Adult Day Care Clinic/Center	032347	MO

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1609957414
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MEDICALODGES, INC.

Provider Business Mailing Address
First Line	:	509 W ROGERS ST
Second Line	:
City	:	CLINTON
State	:	MO
Zip	:	64735-2548
Country	:	US
Telephone Number	:	660-885-9770
Fax Number	:	660-885-9844

Provider Business Practice Location Address
First Line	:	509 W ROGERS ST
Second Line	:
City	:	CLINTON
State	:	MO
Zip	:	64735-2548
Country	:	US
Telephone Number	:	660-885-9770
Fax Number	:	660-885-9844

Authorized Official
Title or Position	:	CHIEF FINANCIAL OFFICER
Name	:	MS. CATHY W FISHER
Credential	:
Telephone Number	:	620-251-6700

Provider Enumeration Date	:	10/18/2006
Last Update Date	:	06/23/2008

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Directions to “MEDICALODGES, INC. ” Practice Location

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