Healthcare Provider Details

I. General information

NPI: 1346319548
Provider Name (Legal Business Name): NORTHEAST MISSOURI ASSOCIATES, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/06/2006
Last Update Date: 07/06/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

HWY 136
LANCASTER MO
63548
US

IV. Provider business mailing address

PO BOX 295
LANCASTER MO
63548-0295
US

V. Phone/Fax

Practice location:
  • Phone: 660-457-3772
  • Fax: 660-457-3110
Mailing address:
  • Phone: 660-457-3772
  • Fax: 660-045-7311

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberR4F20
License Number StateMO

VIII. Authorized Official

Name: RICHARD EARL MINTER
Title or Position: OWNER
Credential: D.O.
Phone: 660-457-3772