Healthcare Provider Details

I. General information

NPI: 1417548132
Provider Name (Legal Business Name): NOBLE HEALTH AUDRAIN INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/27/2021
Last Update Date: 06/23/2022
Certification Date: 06/23/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

111 W BATES ST
WELLSVILLE MO
63384-1616
US

IV. Provider business mailing address

111 W BATES ST
WELLSVILLE MO
63384-1616
US

V. Phone/Fax

Practice location:
  • Phone: 573-684-2208
  • Fax: 573-684-3277
Mailing address:
  • Phone: 573-684-2208
  • Fax: 573-684-3277

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QR1300X
TaxonomyRural Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: AMY L OBRIEN
Title or Position: CEO
Credential:
Phone: 573-582-5000