Provider Demographics
NPI:1043441124
Name:DRS DECKARD AND NEELY
Entity Type:Organization
Organization Name:DRS DECKARD AND NEELY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:RECEPTIONIST
Authorized Official - Prefix:
Authorized Official - First Name:MARY
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:BECKERS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:417-882-1822
Mailing Address - Street 1:3230 E RIDGEVIEW ST
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:MO
Mailing Address - Zip Code:65804-4076
Mailing Address - Country:US
Mailing Address - Phone:417-882-1822
Mailing Address - Fax:417-882-7476
Practice Address - Street 1:3230 E RIDGEVIEW ST
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:MO
Practice Address - Zip Code:65804-4076
Practice Address - Country:US
Practice Address - Phone:417-882-1822
Practice Address - Fax:417-882-7476
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-08-06
Last Update Date:2009-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO33472174400000X
MO2003014006174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO000000654OtherMEDICARE PTAN NUMBER
MO000000654OtherMEDICARE PTAN NUMBER