Healthcare Provider Details

I. General information

NPI: 1093020380
Provider Name (Legal Business Name): FOUR OAKS INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/11/2010
Last Update Date: 09/23/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1615 W BUSINESS US HIGHWAY 60 SUITE A & B
DEXTER MO
63841-2838
US

IV. Provider business mailing address

731 N MAIN ST P.O. BOX 1210
SIKESTON MO
63801-2151
US

V. Phone/Fax

Practice location:
  • Phone: 573-624-3655
  • Fax: 573-624-4323
Mailing address:
  • Phone: 573-471-1276
  • Fax: 573-472-8504

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251G00000X
TaxonomyCommunity Based Hospice Care Agency
License Number192-4HO
License Number StateMO

VIII. Authorized Official

Name: MR. DONALD B BEDELL
Title or Position: PRESIDENT
Credential:
Phone: 573-471-1276