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General NPI Number Information
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NPI Number | 1548520026
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Entity Type | Organization
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Legal Business Name | SSM AUDRAIN HEALTH CARE, INC.
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Dates
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Enumeration Date | 05/18/2012
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Last Update Date | 05/08/2015
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Provider Practice Location Address
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Address Line | 221 N MAIN ST
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City | PARIS
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State | MO
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Zip | 65275-1328
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Country | US
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Telephone | 660-327-4000
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Fax | 660-327-4007
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Provider Business Mailing Address
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Address Line | 221 N MAIN ST
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City | PARIS
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State | MO
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Zip | 65275-1328
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Country | US
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Telephone | 660-327-4000
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Fax | 660-327-4007
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Authorized Official
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Title or Position | PRESIDENT/CEO
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Name | ROBERT B. VANCONIA
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Credential |
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Telephone | 573-582-8108
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 261QR1300X
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Taxonomy Name | Rural Health Clinic/Center
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License Number |
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License Number State |
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