Healthcare Provider Details

I. General information

NPI: 1912916248
Provider Name (Legal Business Name): AUDRAIN HEALTH CARE, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/05/2006
Last Update Date: 02/15/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

110 W SNEED ST
CENTRALIA MO
65240-1375
US

IV. Provider business mailing address

110 W SNEED ST
CENTRALIA MO
65240-1375
US

V. Phone/Fax

Practice location:
  • Phone: 573-682-1330
  • Fax: 573-682-1936
Mailing address:
  • Phone: 573-682-1330
  • Fax: 573-682-1936

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number
License Number State

VIII. Authorized Official

Name: DAVID A. NEUENDORF
Title or Position: PRESIDENT/CEO
Credential:
Phone: 573-582-8108