Healthcare Provider Details

I. General information

NPI: 1003848060
Provider Name (Legal Business Name): LAMAR NO 1 INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/07/2006
Last Update Date: 02/01/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

206 WEST FIRST STREET
LAMAR MO
64759-1291
US

IV. Provider business mailing address

PO BOX 1210
SIKESTON MO
63801-1210
US

V. Phone/Fax

Practice location:
  • Phone: 417-682-5718
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number045991
License Number StateMO

VIII. Authorized Official

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