MEDICARE: GREGORY W SENSENICH 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	208D00000X	General Practice Physician	R8G84	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	:	1326289869
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	GREGORY W SENSENICH INC

Provider Business Mailing Address
First Line	:	861 FAIRWAY DRIVE
Second Line	:
City	:	CHILLICOTHEE
State	:	MO
Zip	:	64601
Country	:	US
Telephone Number	:	660-646-0000
Fax Number	:	660-646-5404

Provider Business Practice Location Address
First Line	:	861 FAIRWAY DR
Second Line	:
City	:	CHILLICOTHEE
State	:	MO
Zip	:	64601-3673
Country	:	US
Telephone Number	:	660-646-0000
Fax Number	:	660-646-5404

Authorized Official
Title or Position	:	PHYSICIAN/CEO
Name	:	DR. GREGORY W SENSENICH
Credential	:	DO
Telephone Number	:	660-646-0000

Provider Enumeration Date	:	03/12/2009
Last Update Date	:	05/07/2024

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