MEDICARE: DAVIS MANAGEMENT SERVICES, INC.

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
1	314000000X	Skilled Nursing Facility	041609	MO

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1285621185
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DAVIS MANAGEMENT SERVICES, INC.

Provider Business Mailing Address
First Line	:	300 WEST FAIRVIEW STREET
Second Line	:
City	:	KING CITY
State	:	MO
Zip	:	64463-0605
Country	:	US
Telephone Number	:	660-535-4325
Fax Number	:	660-535-4553

Provider Business Practice Location Address
First Line	:	300 WEST FAIRVIEW STREET
Second Line	:
City	:	KING CITY
State	:	MO
Zip	:	64463-0605
Country	:	US
Telephone Number	:	660-535-4325
Fax Number	:	660-535-4553

Authorized Official
Title or Position	:	ADMINISTRATOR
Name	:	MRS. LISA L. MCGHEE
Credential	:	R.N.
Telephone Number	:	660-535-4325

Provider Enumeration Date	:	10/05/2005
Last Update Date	:	05/18/2015

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