Healthcare Provider Details

I. General information

NPI: 1194229252
Provider Name (Legal Business Name): TBH ENTERPRISES, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/22/2018
Last Update Date: 03/22/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

HC 1 8165 BOX
FAIRDEALING MO
63939
US

IV. Provider business mailing address

HC 1 BOX 8165
FAIRDEALING MO
63939
US

V. Phone/Fax

Practice location:
  • Phone: 573-857-2273
  • Fax:
Mailing address:
  • Phone: 573-857-2273
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WW0000X
TaxonomyWound Care Registered Nurse
License Number
License Number StateMO

VIII. Authorized Official

Name: BRENDA HOLMES
Title or Position: OFFICE MANAGER
Credential:
Phone: 573-857-2273