MEDICARE: PREFERRED HOSPICE OF MISSOURI NORTHEAST LLC

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	251G00000X	Community Based Hospice Care Agency	146-HO	MO
2	251G00000X	Community Based Hospice Care Agency	144-3HO	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
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1821025826
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PREFERRED HOSPICE OF MISSOURI NORTHEAST LLC

Provider Business Mailing Address
First Line	:	1220 NORTH MAIN STREET
Second Line	:
City	:	SIKESTON
State	:	MO
Zip	:	63801-4827
Country	:	US
Telephone Number	:	573-481-9625
Fax Number	:	573-481-9639

Provider Business Practice Location Address
First Line	:	301 SOVEREIGN COURT
Second Line	:	SUITE 206
City	:	BALLWIN
State	:	MO
Zip	:	63011-4435
Country	:	US
Telephone Number	:	636-527-9330
Fax Number	:	636-527-9340

Authorized Official
Title or Position	:	MEMBER
Name	:	JAMES C LINCOLN
Credential	:
Telephone Number	:	573-481-9625

Provider Enumeration Date	:	06/26/2006
Last Update Date	:	01/05/2011

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