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General NPI Number Information
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NPI Number | 1578978755
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Entity Type | Organization
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Legal Business Name | ONCARE
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Dates
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Enumeration Date | 06/25/2014
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Last Update Date | 05/05/2015
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Provider Practice Location Address
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Address Line | 918 SUNSHINE DR
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City | MOUNT VERNON
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State | MO
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Zip | 65712-1735
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Country | US
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Telephone | 417-553-9583
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Fax | 417-553-9585
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Provider Business Mailing Address
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Address Line | 918 SUNSHINE DR
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City | MOUNT VERNON
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State | MO
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Zip | 65712-1735
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Country | US
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Telephone | 417-553-9583
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Fax | 417-553-9585
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Authorized Official
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Title or Position | OWNER
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Name | DR. KEVIN W LOUDERBACK
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Credential | PSYD HHP MHT PHD
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Telephone | 417-553-9583
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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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