Healthcare Provider Details

I. General information

NPI: 1043441124
Provider Name (Legal Business Name): DRS DECKARD AND NEELY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/06/2009
Last Update Date: 08/06/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3230 E RIDGEVIEW ST
SPRINGFIELD MO
65804-4076
US

IV. Provider business mailing address

3230 E RIDGEVIEW ST
SPRINGFIELD MO
65804-4076
US

V. Phone/Fax

Practice location:
  • Phone: 417-882-1822
  • Fax: 417-882-7476
Mailing address:
  • Phone: 417-882-1822
  • Fax: 417-882-7476

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code174400000X
TaxonomySpecialist
License Number33472
License Number StateMO
# 2
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number2003014006
License Number StateMO

VIII. Authorized Official

Name: MARY ANN BECKERS
Title or Position: RECEPTIONIST
Credential:
Phone: 417-882-1822