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General NPI Number Information
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NPI Number | 1619410198
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Entity Type | Organization
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Legal Business Name | IHC OF MID MISSOURI, LLC
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Dates
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Enumeration Date | 12/01/2016
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Last Update Date | 12/01/2016
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Provider Practice Location Address
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Address Line | 303 N STADIUM BLVD 2ND FLOOR
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City | COLUMBIA
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State | MO
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Zip | 65203-1493
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Country | US
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Telephone | 573-458-5330
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Fax | 877-240-6523
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Provider Business Mailing Address
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Address Line | 13725 METCALF AVE SUITE 411
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City | OVERLAND PARK
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State | KS
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Zip | 66223-7899
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Country | US
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Telephone | 210-213-0248
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Fax |
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Authorized Official
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Title or Position | DIRECTOR OF OPERATIONS
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Name | GARY BODONY
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Credential |
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Telephone | 573-458-5990
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251E00000X
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Taxonomy Name | Home Health Agency
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License Number |
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License Number State |
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