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NPI Code Detail

MEDICARE: ORION HEALTHCARE MISSOURI, LLC

MEDICARE: ORION HEALTHCARE MISSOURI, LLC
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1261QH0100XHealth Service Clinic/CenterLC0965475MO

General Provider Information

NPI Number : 1043447824
Entity Type Code : Organization
Provider Name (Legal Business Name) : ORION HEALTHCARE MISSOURI, LLC
Provider Business Mailing Address
First Line : 1841 N ROCK ROAD CT STE 100
Second Line :
City : WICHITA
State : KS
Zip : 67206-4202
Country : US
Telephone Number : 316-683-2323
Fax Number : 316-683-1778
Provider Business Practice Location Address
First Line : 2740 N MAYFAIR AVE
Second Line :
City : SPRINGFIELD
State : MO
Zip : 65803-5084
Country : US
Telephone Number : 417-521-3925
Fax Number : 417-521-6860
Authorized Official
Title or Position : CEO/PRESIDENT
Name : DUKE C NAIPOHN
Credential :
Telephone Number : 316-683-2323
Provider Enumeration Date : 06/18/2009
Last Update Date : 06/18/2009

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