Healthcare Provider Details

I. General information

NPI: 1336389865
Provider Name (Legal Business Name): CAH ACQUISITION COMPANY 6 LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/24/2009
Last Update Date: 04/27/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

607 S MAIN STREET SUITE B
CONCORDIA MO
64021
US

IV. Provider business mailing address

607 S MAIN STREET SUITE B
CONCORDIA MO
64021
US

V. Phone/Fax

Practice location:
  • Phone: 660-463-1010
  • Fax: 660-463-1070
Mailing address:
  • Phone: 660-463-1010
  • Fax: 660-463-1070

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QP2300X
TaxonomyPrimary Care Clinic/Center
License Number
License Number StateMO
# 2
Primary TaxonomyY
Taxonomy Code261QP2300X
TaxonomyPrimary Care Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MRS. JULIE A DAVENPORT
Title or Position: CEO
Credential:
Phone: 660-335-4700