MEDICARE: ONCARE

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	207Q00000X	Family Medicine Physician

General Provider Information

NPI Number	:	1578978755
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ONCARE

Provider Business Mailing Address
First Line	:	918 SUNSHINE DR
Second Line	:
City	:	MOUNT VERNON
State	:	MO
Zip	:	65712-1735
Country	:	US
Telephone Number	:	417-553-9583
Fax Number	:	417-553-9585

Provider Business Practice Location Address
First Line	:	918 SUNSHINE DR
Second Line	:
City	:	MOUNT VERNON
State	:	MO
Zip	:	65712-1735
Country	:	US
Telephone Number	:	417-553-9583
Fax Number	:	417-553-9585

Authorized Official
Title or Position	:	OWNER
Name	:	DR. KEVIN W LOUDERBACK
Credential	:	PSYD HHP MHT PHD
Telephone Number	:	417-553-9583

Provider Enumeration Date	:	06/25/2014
Last Update Date	:	05/05/2015

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Directions to “ONCARE ” Practice Location

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