Healthcare Provider Details

I. General information

NPI: 1578795472
Provider Name (Legal Business Name): MISSION MISSOURI
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/12/2009
Last Update Date: 08/12/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

509 RUTH ST
SIKESTON MO
63801-2763
US

IV. Provider business mailing address

PO BOX 1858
SIKESTON MO
63801-1858
US

V. Phone/Fax

Practice location:
  • Phone: 573-481-0505
  • Fax: 573-481-0518
Mailing address:
  • Phone: 573-481-0505
  • Fax: 573-481-0518

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code305S00000X
TaxonomyPoint of Service
License Number
License Number State

VIII. Authorized Official

Name: JANE F PFEFFERKORN
Title or Position: CEO
Credential:
Phone: 573-481-0505