Provider Demographics
NPI:1023579489
Name:CERTIFIED ON-SITE HEALTH CARE LLC
Entity Type:Organization
Organization Name:CERTIFIED ON-SITE HEALTH CARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:NATASHA
Authorized Official - Middle Name:B
Authorized Official - Last Name:HAWKINS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:417-932-1130
Mailing Address - Street 1:805 2ND ST
Mailing Address - Street 2:
Mailing Address - City:SUMMERSVILLE
Mailing Address - State:MO
Mailing Address - Zip Code:65571-8714
Mailing Address - Country:US
Mailing Address - Phone:417-932-1130
Mailing Address - Fax:417-932-1127
Practice Address - Street 1:805 2ND ST
Practice Address - Street 2:
Practice Address - City:SUMMERSVILLE
Practice Address - State:MO
Practice Address - Zip Code:65571-8714
Practice Address - Country:US
Practice Address - Phone:417-932-1130
Practice Address - Fax:417-932-1127
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-03-28
Last Update Date:2019-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care