Healthcare Provider Details

I. General information

NPI: 1720060304
Provider Name (Legal Business Name): FC OF MISSOURI INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/18/2005
Last Update Date: 04/19/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4305 S. NATIONAL AVE
SPRINGFIELD MO
65810-2607
US

IV. Provider business mailing address

4055 VALLEY VIEW LN 5TH FLOOR
DALLAS TX
75244-5074
US

V. Phone/Fax

Practice location:
  • Phone: 417-883-5118
  • Fax: 417-883-7436
Mailing address:
  • Phone: 214-445-3750
  • Fax: 214-445-3902

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberHHA7502
License Number StateMO
# 2
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number943539809
License Number StateMO
# 3
Primary TaxonomyN
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License NumberHHA7502
License Number StateMO
# 4
Primary TaxonomyN
Taxonomy Code3747P1801X
TaxonomyPersonal Care Attendant
License Number263539801
License Number StateMO
# 5
Primary TaxonomyN
Taxonomy Code374U00000X
TaxonomyHome Health Aide
License Number0002286
License Number StateMO
# 6
Primary TaxonomyN
Taxonomy Code376J00000X
TaxonomyHomemaker
License NumberHHA7502
License Number StateMO
# 7
Primary TaxonomyN
Taxonomy Code376J00000X
TaxonomyHomemaker
License Number283539807
License Number StateMO
# 8
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number750-7HH
License Number StateMO

VIII. Authorized Official

Name: MR. PAUL D FOSTER
Title or Position: CEO
Credential:
Phone: 214-445-3750