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General NPI Number Information
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NPI Number | 1952540874
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Entity Type | Organization
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Legal Business Name | AMERICAN RED CROSS
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Dates
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Enumeration Date | 02/17/2009
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Last Update Date | 02/17/2009
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Provider Practice Location Address
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Address Line | 1511 S PROVIDENCE RD
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City | COLUMBIA
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State | MO
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Zip | 65203-3535
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Country | US
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Telephone | 573-449-2656
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Fax | 573-443-3831
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Provider Business Mailing Address
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Address Line | 1511 S PROVIDENCE RD
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City | COLUMBIA
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State | MO
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Zip | 65203-3535
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Country | US
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Telephone | 573-449-2656
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Fax | 573-443-3831
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Authorized Official
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Title or Position | MANAGER, CLINICAL SERVICES
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Name | MR. WALLY L THOMAS
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Credential | MT, ASCP
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Telephone | 573-449-2656
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QE0700X
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Taxonomy Name | End-Stage Renal Disease (ESRD) Treatment Clinic/Center
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License Number | 26D0652375
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License Number State | MO
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