=====================================================
General NPI Number Information
=====================================================
NPI Number | 1588575153
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | HERITAGE HEALTH LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/14/2026
-----------------------------------------------------
Last Update Date | 09/14/2026
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 4335 US 160
-----------------------------------------------------
City | KOSHKONONG
-----------------------------------------------------
State | MO
-----------------------------------------------------
Zip | 65692-9770
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 417-794-4188
-----------------------------------------------------
Fax | 417-384-3875
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 4335 US 160
-----------------------------------------------------
City | KOSHKONONG
-----------------------------------------------------
State | MO
-----------------------------------------------------
Zip | 65692-9770
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 417-794-4188
-----------------------------------------------------
Fax | 417-384-3875
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER/PHYSICIAN
-----------------------------------------------------
Name | DR. SCOTT F ROUSH
-----------------------------------------------------
Credential | DO
-----------------------------------------------------
Telephone | 417-372-2694
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207QH0002X
-----------------------------------------------------
Taxonomy Name | Hospice and Palliative Medicine (Family Medicine) Physician
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------