Healthcare Provider Details

I. General information

NPI: 1639219967
Provider Name (Legal Business Name): PHILIP GREG ORDWAY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/07/2007
Last Update Date: 06/18/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

105 GALEWOOD DR
BRANSON MO
65616-7289
US

IV. Provider business mailing address

106 GALEWOOD DR
BRANSON MO
65616-7289
US

V. Phone/Fax

Practice location:
  • Phone: 417-336-8831
  • Fax:
Mailing address:
  • Phone: 417-336-8831
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code385HR2060X
TaxonomyChild Intellectual and/or Developmental Disabilities Respite Care
License Number
License Number State

VIII. Authorized Official

Name: GREG ORDWAY
Title or Position: DIRECTOR
Credential:
Phone: 417-336-8831