MEDICARE: PREFERRED FAMILY HEALTHCARE

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	251S00000X	Community/Behavioral Health Agency	1199	MO

General Provider Information

NPI Number	:	1295867042
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PREFERRED FAMILY HEALTHCARE

Provider Business Mailing Address
First Line	:	900 E LAHARPE ST
Second Line	:
City	:	KIRKSVILLE
State	:	MO
Zip	:	63501-4520
Country	:	US
Telephone Number	:	660-665-1962
Fax Number	:	660-665-3989

Provider Business Practice Location Address
First Line	:	4411 N NEWSTEAD AVE
Second Line	:	SUITE 200
City	:	SAINT LOUIS
State	:	MO
Zip	:	63115-2534
Country	:	US
Telephone Number	:	314-932-1207
Fax Number	:	314-932-1209

Authorized Official
Title or Position	:	CREDENTIALING SPECIALIST
Name	:	MRS. DORIS SAWYER
Credential	:	MAE
Telephone Number	:	660-626-0404

Provider Enumeration Date	:	03/09/2007
Last Update Date	:	09/25/2013

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Directions to “PREFERRED FAMILY HEALTHCARE ” Practice Location

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