Provider Demographics
NPI:1043485873
Name:MASSEY FAMILY CARE
Entity Type:Organization
Organization Name:MASSEY FAMILY CARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR OF OPERATIONS
Authorized Official - Prefix:MRS
Authorized Official - First Name:AMY
Authorized Official - Middle Name:D
Authorized Official - Last Name:LEDBETTER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:573-651-4488
Mailing Address - Street 1:304 TEACO RD
Mailing Address - Street 2:SUITE B
Mailing Address - City:KENNETT
Mailing Address - State:MO
Mailing Address - Zip Code:63857-3266
Mailing Address - Country:US
Mailing Address - Phone:573-888-6100
Mailing Address - Fax:573-888-6184
Practice Address - Street 1:304 TEACO RD
Practice Address - Street 2:SUITE B
Practice Address - City:KENNETT
Practice Address - State:MO
Practice Address - Zip Code:63857-3266
Practice Address - Country:US
Practice Address - Phone:573-888-6100
Practice Address - Fax:573-888-6184
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-04-23
Last Update Date:2008-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO500445408Medicaid