Healthcare Provider Details

I. General information

NPI: 1972232957
Provider Name (Legal Business Name): TROUTMAN ENTERPRISES, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/06/2022
Last Update Date: 06/06/2022
Certification Date: 06/06/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1331 N STEWART AVE
SPRINGFIELD MO
65802-2239
US

IV. Provider business mailing address

1331 N STEWART AVE
SPRINGFIELD MO
65802-2239
US

V. Phone/Fax

Practice location:
  • Phone: 417-593-2789
  • Fax:
Mailing address:
  • Phone: 417-593-2789
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA0600X
TaxonomyAdult Day Care Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: SAMANTHA TROUTMAN
Title or Position: OWNER
Credential:
Phone: 417-593-2789