Provider Demographics
NPI:1093397168
Name:FREUDENTHAL PRIMARY CARE FOR SENIORS, LLC
Entity Type:Organization
Organization Name:FREUDENTHAL PRIMARY CARE FOR SENIORS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:JOSEPH
Authorized Official - Middle Name:
Authorized Official - Last Name:FREUDENTHAL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:816-387-8881
Mailing Address - Street 1:2425 N WOODBINE RD STE A
Mailing Address - Street 2:
Mailing Address - City:SAINT JOSEPH
Mailing Address - State:MO
Mailing Address - Zip Code:64506-3647
Mailing Address - Country:US
Mailing Address - Phone:816-387-8881
Mailing Address - Fax:816-387-8792
Practice Address - Street 1:2425 N. WOODBINE ROAD
Practice Address - Street 2:
Practice Address - City:ST. JOSEPH
Practice Address - State:MO
Practice Address - Zip Code:64506
Practice Address - Country:US
Practice Address - Phone:816-387-8881
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-04-27
Last Update Date:2022-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207QG0300XAllopathic & Osteopathic PhysiciansFamily MedicineGeriatric MedicineGroup - Single Specialty