=====================================================
General NPI Number Information
=====================================================
NPI Number | 1306860846
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | BOONE HOSPITAL CENTER'S VISITING NURSES, INC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/27/2006
-----------------------------------------------------
Last Update Date | 03/19/2009
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 601 BUSINESS LOOP 70 W SUITE 280
-----------------------------------------------------
City | COLUMBIA
-----------------------------------------------------
State | MO
-----------------------------------------------------
Zip | 65203-2522
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 573-875-0555
-----------------------------------------------------
Fax | 573-875-1062
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 601 BUSINESS LOOP 70 W SUITE 280
-----------------------------------------------------
City | COLUMBIA
-----------------------------------------------------
State | MO
-----------------------------------------------------
Zip | 65203-2522
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 573-875-0555
-----------------------------------------------------
Fax | 573-875-1062
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | VICE PRESIDENT & COO
-----------------------------------------------------
Name | RANDY M MARROW
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 573-815-8000
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 251E00000X
-----------------------------------------------------
Taxonomy Name | Home Health Agency
-----------------------------------------------------
License Number | 639-8
-----------------------------------------------------
License Number State | MO
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 332B00000X
-----------------------------------------------------
Taxonomy Name | Durable Medical Equipment & Medical Supplies
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------