Healthcare Provider Details

I. General information

NPI: 1679761449
Provider Name (Legal Business Name): AUDRAIN HEALTH CARE, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/05/2007
Last Update Date: 11/07/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

201 E MONROE ST
MEXICO MO
65265-2852
US

IV. Provider business mailing address

201 E MONROE ST
MEXICO MO
65265-2852
US

V. Phone/Fax

Practice location:
  • Phone: 573-581-7582
  • Fax: 573-581-7583
Mailing address:
  • Phone: 573-581-7582
  • Fax: 573-581-7583

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208800000X
TaxonomyUrology Physician
License Number31266
License Number StateMO

VIII. Authorized Official

Name: MR. DAVE NEUENDORF
Title or Position: PRESIDENT/CEO
Credential:
Phone: 573-582-8108