Provider Demographics
NPI:1043944499
Name:NOBLE HEALTH AUDRAIN INC
Entity Type:Organization
Organization Name:NOBLE HEALTH AUDRAIN INC
Other - Org Name:SEDALIA SPECIALTY CLINIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:AMY
Authorized Official - Middle Name:L
Authorized Official - Last Name:OBRIEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:573-582-5000
Mailing Address - Street 1:620 E MONROE ST
Mailing Address - Street 2:
Mailing Address - City:MEXICO
Mailing Address - State:MO
Mailing Address - Zip Code:65265-2919
Mailing Address - Country:US
Mailing Address - Phone:573-582-5000
Mailing Address - Fax:573-582-3700
Practice Address - Street 1:2100 W MAIN ST
Practice Address - Street 2:
Practice Address - City:SEDALIA
Practice Address - State:MO
Practice Address - Zip Code:65301-2351
Practice Address - Country:US
Practice Address - Phone:660-826-5750
Practice Address - Fax:660-829-0213
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:NOBLE HEALTH AUDRAIN INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2022-07-12
Last Update Date:2022-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryGroup - Single Specialty