MEDICARE: PREFERRED FAMILY HEALTHCARE INC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy
1	261QP2300X	Primary Care Clinic/Center
2	251S00000X	Community/Behavioral Health Agency
3	261QD0000X	Dental Clinic/Center
4	261QF0400X	Federally Qualified Health Center (FQHC)

General Provider Information

NPI Number	:	1467001248
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PREFERRED FAMILY HEALTHCARE INC

Provider Business Mailing Address
First Line	:	1601 OLD SOUTH RIVER RD
Second Line	:
City	:	SAINT CHARLES
State	:	MO
Zip	:	63303-4120
Country	:	US
Telephone Number	:	636-224-1210
Fax Number	:	636-246-1008

Provider Business Practice Location Address
First Line	:	400 SALISBURY ST
Second Line	:
City	:	MONTGOMERY CITY
State	:	MO
Zip	:	63361-1232
Country	:	US
Telephone Number	:	573-603-1460
Fax Number	:	573-603-1462

Authorized Official
Title or Position	:	CHIEF REVENUE OFFICER
Name	:	MARK CONOVER
Credential	:
Telephone Number	:	573-603-1460

Provider Enumeration Date	:	09/05/2019
Last Update Date	:	07/29/2022

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