Provider Demographics
NPI:1225006224
Name:TAKE CARE HEALTH MISSOURI, PC
Entity Type:Organization
Organization Name:TAKE CARE HEALTH MISSOURI, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF FINANCIAL OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:JEFFREY
Authorized Official - Middle Name:
Authorized Official - Last Name:PETRICK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:484-351-3220
Mailing Address - Street 1:300 BARR HARBOR DRIVE
Mailing Address - Street 2:SUITE 550, FIVE TOWER BRIDGE
Mailing Address - City:CONSHOHOCKEN
Mailing Address - State:PA
Mailing Address - Zip Code:19428
Mailing Address - Country:US
Mailing Address - Phone:866-825-3227
Mailing Address - Fax:
Practice Address - Street 1:330 N. E. BARRY ROAD
Practice Address - Street 2:
Practice Address - City:KANSAS CITY
Practice Address - State:MO
Practice Address - Zip Code:64155
Practice Address - Country:US
Practice Address - Phone:866-825-3227
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-03-08
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MOT580000Medicare ID - Type UnspecifiedMEDICARE GROUP NUMBER