Provider Demographics
NPI:1184209538
Name:NOBLE HEALTH AUDRAIN INC
Entity Type:Organization
Organization Name:NOBLE HEALTH AUDRAIN INC
Other - Org Name:AUDRAIN COMM CLINIC AUXVASSE
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 1:201 S. MAIN STREET
Mailing Address - Street 2:
Mailing Address - City:AUXVASSE
Mailing Address - State:MO
Mailing Address - Zip Code:65231-1624
Mailing Address - Country:US
Mailing Address - Phone:573-386-5959
Mailing Address - Fax:573-386-5995
Practice Address - Street 1:201 S. MAIN STREET
Practice Address - Street 2:
Practice Address - City:AUXVASSE
Practice Address - State:MO
Practice Address - Zip Code:65231-1624
Practice Address - Country:US
Practice Address - Phone:573-386-5959
Practice Address - Fax:573-386-5995
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:NOBLE HEALTH AUDRAIN INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2021-03-16
Last Update Date:2022-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR1300XAmbulatory Health Care FacilitiesClinic/CenterRural Health