MEDICARE: MR. SAM L DEMPEY M.A.

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	103K00000X	Behavior Analyst

General Provider Information

NPI Number	:	1669746061
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. SAM L DEMPEY M.A.

Provider Business Mailing Address
First Line	:	PO BOX 71
Second Line	:
City	:	KENNETT
State	:	MO
Zip	:	63857-0071
Country	:	US
Telephone Number	:	573-888-0642
Fax Number	:	573-888-8833

Provider Business Practice Location Address
First Line	:	935 HWY VV
Second Line	:	935 HWY VV
City	:	KENNETT
State	:	MO
Zip	:	63857-0071
Country	:	US
Telephone Number	:	573-888-0642
Fax Number	:	573-888-8833

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/02/2012
Last Update Date	:	03/02/2012

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