Healthcare Provider Details

I. General information

NPI: 1447653183
Provider Name (Legal Business Name): PA ENTERPRISES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/08/2014
Last Update Date: 07/15/2026
Certification Date: 07/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

519 MAIN ST
MILLIGAN NE
68406-3953
US

IV. Provider business mailing address

PO BOX 3907
POPLAR BLUFF MO
63902-3907
US

V. Phone/Fax

Practice location:
  • Phone: 402-745-6279
  • Fax:
Mailing address:
  • Phone: 402-745-6279
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: SCOTT VONDERFECHT
Title or Position: OWNER
Credential: MD
Phone: 402-745-6279