Healthcare Provider Details

I. General information

NPI: 1134786494
Provider Name (Legal Business Name): SILVERTIP MEDICAL SERVICES, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/22/2019
Last Update Date: 05/22/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10430 TINDALL RD
CADET MO
63630-8283
US

IV. Provider business mailing address

10430 TINDALL RD
CADET MO
63630-8283
US

V. Phone/Fax

Practice location:
  • Phone: 573-438-7778
  • Fax:
Mailing address:
  • Phone: 573-438-7778
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM1300X
TaxonomyMulti-Specialty Clinic/Center
License Number
License Number State

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
Identifier9876
Identifier TypeOTHER
Identifier StateMO
Identifier IssuerIRS

VIII. Authorized Official

Name: MS. LINDA DECLUE
Title or Position: MANAGER
Credential:
Phone: 573-438-7778