=====================================================
General NPI Number Information
=====================================================
NPI Number | 1164612818
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | HEALTHNET REGIONAL CENTER OF CUBA, INC..
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/30/2007
-----------------------------------------------------
Last Update Date | 02/07/2008
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 108 BUCHANAN
-----------------------------------------------------
City | CUBA
-----------------------------------------------------
State | MO
-----------------------------------------------------
Zip | 65453
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 573-885-6000
-----------------------------------------------------
Fax | 573-885-6002
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 38 925 LAKESHORE DR
-----------------------------------------------------
City | CUBA
-----------------------------------------------------
State | MO
-----------------------------------------------------
Zip | 65453
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 573-885-6000
-----------------------------------------------------
Fax | 573-885-6002
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | CEO
-----------------------------------------------------
Name | JAMES G FROESCHNER
-----------------------------------------------------
Credential | CEO
-----------------------------------------------------
Telephone | 573-885-5005
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 261QR1300X
-----------------------------------------------------
Taxonomy Name | Rural Health Clinic/Center
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------