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General NPI Number Information
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NPI Number | 1114172111
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Entity Type | Organization
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Legal Business Name | KENNETT HMA PHYSICIAN MANAGEMENT, INC.
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Dates
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Enumeration Date | 11/19/2008
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Last Update Date | 11/19/2008
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Provider Practice Location Address
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Address Line | 1301 1ST ST
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City | KENNETT
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State | MO
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Zip | 63857-2525
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Country | US
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Telephone | 573-888-8424
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Fax | 573-888-2715
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Provider Business Mailing Address
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Address Line | 1231 1ST ST SUITE 8
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City | KENNETT
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State | MO
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Zip | 63857-2527
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Country | US
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Telephone | 573-888-8424
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Fax | 573-888-2715
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Authorized Official
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Title or Position | CONTROLLER
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Name | MS. MICHELLE M BEACHAM
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Credential |
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Telephone | 573-888-8424
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 367500000X
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Taxonomy Name | Certified Registered Nurse Anesthetist
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License Number |
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License Number State |
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