Provider Demographics
NPI:1104192749
Name:CENTRAL CARE, PA
Entity Type:Organization
Organization Name:CENTRAL CARE, PA
Other - Org Name:CENTRAL CARE CANCER CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR OF BILLING
Authorized Official - Prefix:
Authorized Official - First Name:WENDY
Authorized Official - Middle Name:J
Authorized Official - Last Name:LEITH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:785-823-0633
Mailing Address - Street 1:PO BOX 256
Mailing Address - Street 2:
Mailing Address - City:SALINA
Mailing Address - State:KS
Mailing Address - Zip Code:67402-0256
Mailing Address - Country:US
Mailing Address - Phone:785-823-0633
Mailing Address - Fax:785-823-0658
Practice Address - Street 1:2828 N NATIONAL AVE
Practice Address - Street 2:SUITE A
Practice Address - City:SPRINGFIELD
Practice Address - State:MO
Practice Address - Zip Code:65803-4306
Practice Address - Country:US
Practice Address - Phone:417-875-4600
Practice Address - Fax:417-875-4700
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:CENTRAL CARE, PA
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2012-03-28
Last Update Date:2014-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO002905174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MOMA3744Medicare PIN