Healthcare Provider Details

I. General information

NPI: 1891739033
Provider Name (Legal Business Name): SHEPHERD'S VIEW, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/16/2006
Last Update Date: 07/11/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 SHEPHERDS LANE
ALTON MO
65606
US

IV. Provider business mailing address

100 SHEPHERDS LANE PO BOX 429
ALTON MO
65606
US

V. Phone/Fax

Practice location:
  • Phone: 417-778-7959
  • Fax: 417-778-1849
Mailing address:
  • Phone: 417-778-7959
  • Fax: 417-778-1849

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QP2300X
TaxonomyPrimary Care Clinic/Center
License Number030781
License Number StateMO

VIII. Authorized Official

Name: MRS. BECKIE DAWN COMBS
Title or Position: PRESIDENT
Credential:
Phone: 417-778-7959