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NPI Code Detail

MEDICARE: BUFFALO PRAIRIE OPERATIONS MANAGEMENT LLC

MEDICARE: BUFFALO PRAIRIE OPERATIONS MANAGEMENT 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
1314000000XSkilled Nursing Facility

General Provider Information

NPI Number : 1326587916
Entity Type Code : Organization
Provider Name (Legal Business Name) : BUFFALO PRAIRIE OPERATIONS MANAGEMENT LLC
Provider Business Mailing Address
First Line : 33 WEDGEWOOD LN
Second Line :
City : LAWRENCE
State : NY
Zip : 11559-1451
Country : US
Telephone Number : 917-836-0436
Fax Number :
Provider Business Practice Location Address
First Line : 631 W MAIN ST
Second Line :
City : BUFFALO
State : MO
Zip : 65622-7496
Country : US
Telephone Number : 417-345-5422
Fax Number :
Authorized Official
Title or Position : MANAGING MEMBER
Name : GERALD STOLL
Credential :
Telephone Number : 917-836-0436
Provider Enumeration Date : 02/16/2017
Last Update Date : 02/16/2017

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Directions to “BUFFALO PRAIRIE OPERATIONS MANAGEMENT LLC ” Practice Location

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