Healthcare Provider Details

I. General information

NPI: 1548296304
Provider Name (Legal Business Name): PREFERRED HOSPICE OF MISSOURI LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/23/2006
Last Update Date: 01/05/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

423 BUSINESS HIGHWAY 60 WEST
DEXTER MO
63841-1121
US

IV. Provider business mailing address

1220 NORTH MAIN STREET
SIKESTON MO
63801-4827
US

V. Phone/Fax

Practice location:
  • Phone: 573-614-4774
  • Fax: 573-614-4775
Mailing address:
  • Phone: 573-481-9625
  • Fax: 573-481-9639

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code251G00000X
TaxonomyCommunity Based Hospice Care Agency
License Number139-HO
License Number StateMO
# 2
Primary TaxonomyY
Taxonomy Code251G00000X
TaxonomyCommunity Based Hospice Care Agency
License Number139-3HO
License Number StateMO

VIII. Authorized Official

Name: JAMES C LINCOLN
Title or Position: MEMBER
Credential:
Phone: 573-481-9625