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NPI Code Detail

MEDICARE: FAIR GROVE R-X

MEDICARE: FAIR GROVE R-X
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
1251300000XLocal Education Agency (LEA)

General Provider Information

NPI Number : 1982077178
Entity Type Code : Organization
Provider Name (Legal Business Name) : FAIR GROVE R-X
Provider Business Mailing Address
First Line : 132 N MAIN ST
Second Line :
City : FAIR GROVE
State : MO
Zip : 65648-8436
Country : US
Telephone Number : 417-759-2233
Fax Number : 417-759-7150
Provider Business Practice Location Address
First Line : 132 N MAIN ST
Second Line :
City : FAIR GROVE
State : MO
Zip : 65648-8436
Country : US
Telephone Number : 417-759-2233
Fax Number : 417-759-7150
Authorized Official
Title or Position : BUSINESS MANAGER
Name : JANET REEVES
Credential :
Telephone Number : 417-759-2233
Provider Enumeration Date : 11/10/2015
Last Update Date : 11/10/2015

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Directions to “FAIR GROVE R-X ” Practice Location

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