MEDICARE: PRIMROSE PLACE 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	030605	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	:	1457334880
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PRIMROSE PLACE INC

Provider Business Mailing Address
First Line	:	1115 E PRIMROSE ST
Second Line	:
City	:	SPRINGFIELD
State	:	MO
Zip	:	65807-5146
Country	:	US
Telephone Number	:	417-269-9010
Fax Number	:	417-269-9966

Provider Business Practice Location Address
First Line	:	1115 E PRIMROSE ST
Second Line	:
City	:	SPRINGFIELD
State	:	MO
Zip	:	65807-5146
Country	:	US
Telephone Number	:	417-269-9010
Fax Number	:	417-269-9966

Authorized Official
Title or Position	:	VICE PRESIDENT
Name	:	MR. RON PRENGER
Credential	:
Telephone Number	:	417-269-9010

Provider Enumeration Date	:	11/21/2005
Last Update Date	:	09/10/2009

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Directions to “PRIMROSE PLACE INC ” Practice Location

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