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General NPI Number Information
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NPI Number | 1679761449
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Entity Type | Organization
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Legal Business Name | AUDRAIN HEALTH CARE, INC.
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Dates
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Enumeration Date | 10/05/2007
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Last Update Date | 11/07/2007
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Provider Practice Location Address
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Address Line | 201 E MONROE ST
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City | MEXICO
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State | MO
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Zip | 65265-2852
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Country | US
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Telephone | 573-581-7582
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Fax | 573-581-7583
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Provider Business Mailing Address
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Address Line | 201 E MONROE ST
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City | MEXICO
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State | MO
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Zip | 65265-2852
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Country | US
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Telephone | 573-581-7582
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Fax | 573-581-7583
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Authorized Official
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Title or Position | PRESIDENT/CEO
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Name | MR. DAVE NEUENDORF
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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 | 208800000X
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Taxonomy Name | Urology Physician
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License Number | 31266
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License Number State | MO
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