=====================================================
General NPI Number Information
=====================================================
NPI Number | 1942509013
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | CAH ACQUISITION COMPANY 6 LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/15/2011
-----------------------------------------------------
Last Update Date | 05/18/2011
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 206 S COUNTY RD
-----------------------------------------------------
City | ALMA
-----------------------------------------------------
State | MO
-----------------------------------------------------
Zip | 64001
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 660-674-2403
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 214
-----------------------------------------------------
City | ALMA
-----------------------------------------------------
State | MO
-----------------------------------------------------
Zip | 64001-0214
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 660-674-2403
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | CEO
-----------------------------------------------------
Name | MRS. JULIE A DAVENPORT
-----------------------------------------------------
Credential | RN
-----------------------------------------------------
Telephone | 660-335-7408
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 261QR1300X
-----------------------------------------------------
Taxonomy Name | Rural Health Clinic/Center
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------