Healthcare Provider Details

I. General information

NPI: 1326289869
Provider Name (Legal Business Name): GREGORY W SENSENICH INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/12/2009
Last Update Date: 05/07/2024
Certification Date: 05/07/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

861 FAIRWAY DR
CHILLICOTHEE MO
64601-3673
US

IV. Provider business mailing address

861 FAIRWAY DRIVE
CHILLICOTHEE MO
64601
US

V. Phone/Fax

Practice location:
  • Phone: 660-646-0000
  • Fax: 660-646-5404
Mailing address:
  • Phone: 660-646-0000
  • Fax: 660-646-5404

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License NumberR8G84
License Number StateMO

VIII. Authorized Official

Name: DR. GREGORY W SENSENICH
Title or Position: PHYSICIAN/CEO
Credential: DO
Phone: 660-646-0000