Healthcare Provider Details

I. General information

NPI: 1922070903
Provider Name (Legal Business Name): MASSEY FAMILY CARE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/03/2006
Last Update Date: 09/06/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

304 TEACO RD STE B
KENNETT MO
63857
US

IV. Provider business mailing address

304 TEACO RD STE B
KENNETT MO
63857
US

V. Phone/Fax

Practice location:
  • Phone: 573-888-6100
  • Fax: 573-888-6184
Mailing address:
  • Phone: 573-888-6100
  • Fax: 573-888-6184

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code261QR1300X
TaxonomyRural Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MINA KAY MASSEY
Title or Position: MD OWNER
Credential: MD
Phone: 573-888-6100