Healthcare Provider Details

I. General information

NPI: 1306867429
Provider Name (Legal Business Name): ASHLAR MEDICAL, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/22/2006
Last Update Date: 04/08/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1908 GREENWOOD DR STE B
POPLAR BLUFF MO
63901-2430
US

IV. Provider business mailing address

816 UNIVERSITY PKWY
NATCHITOCHES LA
71457
US

V. Phone/Fax

Practice location:
  • Phone: 573-785-8766
  • Fax: 573-785-8769
Mailing address:
  • Phone: 318-352-8075
  • Fax: 318-357-1535

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code247200000X
TaxonomyOther Technician
License Number
License Number State

VIII. Authorized Official

Name: MS. CYNTHIA MARIE LINVILLE
Title or Position: CHIEF EXECUTIVE OFFICER
Credential:
Phone: 573-785-8766