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NPI Code Detail

MEDICARE: INDIAN HILLS RETIREMENT

MEDICARE: INDIAN HILLS RETIREMENT
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
1313M00000XNursing Facility/Intermediate Care Facility031645MO
2314000000XSkilled Nursing Facility031645MO

General Provider Information

NPI Number : 1487636239
Entity Type Code : Organization
Provider Name (Legal Business Name) : INDIAN HILLS RETIREMENT
Provider Business Mailing Address
First Line : 2601 FAIR ST
Second Line :
City : CHILLICOTHEE
State : MO
Zip : 64601-3525
Country : US
Telephone Number : 660-646-1230
Fax Number : 660-707-1198
Provider Business Practice Location Address
First Line : 2601 FAIR ST
Second Line :
City : CHILLICOTHEE
State : MO
Zip : 64601-3525
Country : US
Telephone Number : 660-646-1230
Fax Number : 660-707-1198
Authorized Official
Title or Position : PRESIDENT/OWNER
Name : MR. TOM OTKE
Credential :
Telephone Number : 573-659-6607
Provider Enumeration Date : 11/17/2005
Last Update Date : 02/29/2008

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Directions to “INDIAN HILLS RETIREMENT ” Practice Location

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