Provider Demographics
NPI:1245415389
Name:COMPREHENSIVE FAMILY HEALTH CARE LLC
Entity Type:Organization
Organization Name:COMPREHENSIVE FAMILY HEALTH CARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:ROBIN
Authorized Official - Middle Name:E
Authorized Official - Last Name:MILLER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:573-561-4814
Mailing Address - Street 1:PO BOX 1396
Mailing Address - Street 2:
Mailing Address - City:CAPE GIRARDEAU
Mailing Address - State:MO
Mailing Address - Zip Code:63702-1396
Mailing Address - Country:US
Mailing Address - Phone:573-335-1344
Mailing Address - Fax:573-335-3992
Practice Address - Street 1:142 S WINCHESTER ST
Practice Address - Street 2:
Practice Address - City:BENTON
Practice Address - State:MO
Practice Address - Zip Code:63736-0000
Practice Address - Country:US
Practice Address - Phone:573-335-1344
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-01-08
Last Update Date:2017-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO100630207Q00000X
261QR1300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QR1300XAmbulatory Health Care FacilitiesClinic/CenterRural Health
No207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO1245415389Medicaid
MO221260OtherBCBS
175986OtherHEALTHLINK
MO000015669Medicare PIN
175986OtherHEALTHLINK