Provider Demographics
NPI:1174867766
Name:LINCARE PULMONARY REHAB SERVICES OF MISSOURI, LLC
Entity Type:Organization
Organization Name:LINCARE PULMONARY REHAB SERVICES OF MISSOURI, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:AUTHORIZED OFFICIAL
Authorized Official - Prefix:
Authorized Official - First Name:BRIAN
Authorized Official - Middle Name:
Authorized Official - Last Name:NANNIE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:727-530-7700
Mailing Address - Street 1:19387 US HIGHWAY 19 N
Mailing Address - Street 2:
Mailing Address - City:CLEARWATER
Mailing Address - State:FL
Mailing Address - Zip Code:33764-3102
Mailing Address - Country:US
Mailing Address - Phone:727-431-8261
Mailing Address - Fax:877-408-4602
Practice Address - Street 1:10994 HISTORIC HIGHWAY 165
Practice Address - Street 2:STE C
Practice Address - City:HOLLISTER
Practice Address - State:MO
Practice Address - Zip Code:65672-6234
Practice Address - Country:US
Practice Address - Phone:417-334-1532
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-11-20
Last Update Date:2014-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225400000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRehabilitation PractitionerGroup - Single Specialty