Provider Demographics
NPI:1013216795
Name:GREATER MISSOURI MEDICAL PRO-CARE PROVIDERS, INC
Entity Type:Organization
Organization Name:GREATER MISSOURI MEDICAL PRO-CARE PROVIDERS, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:KAMENDRA
Authorized Official - Middle Name:
Authorized Official - Last Name:MISHRA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:417-782-2917
Mailing Address - Street 1:214 W 5TH ST
Mailing Address - Street 2:
Mailing Address - City:JOPLIN
Mailing Address - State:MO
Mailing Address - Zip Code:64801-2598
Mailing Address - Country:US
Mailing Address - Phone:417-782-2917
Mailing Address - Fax:417-782-7038
Practice Address - Street 1:214 W 5TH ST
Practice Address - Street 2:
Practice Address - City:JOPLIN
Practice Address - State:MO
Practice Address - Zip Code:64801-2598
Practice Address - Country:US
Practice Address - Phone:417-782-2917
Practice Address - Fax:417-782-7038
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-03-21
Last Update Date:2013-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health