Provider Demographics
NPI:1306860846
Name:BOONE HOSPITAL CENTER'S VISITING NURSES, INC
Entity Type:Organization
Organization Name:BOONE HOSPITAL CENTER'S VISITING NURSES, INC
Other - Org Name:BOONE HOSPITAL HOME CARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:VICE PRESIDENT & COO
Authorized Official - Prefix:
Authorized Official - First Name:RANDY
Authorized Official - Middle Name:M
Authorized Official - Last Name:MARROW
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:573-815-8000
Mailing Address - Street 1:601 BUSINESS LOOP 70 W
Mailing Address - Street 2:SUITE 280
Mailing Address - City:COLUMBIA
Mailing Address - State:MO
Mailing Address - Zip Code:65203-2522
Mailing Address - Country:US
Mailing Address - Phone:573-875-0555
Mailing Address - Fax:573-875-1062
Practice Address - Street 1:601 BUSINESS LOOP 70 W
Practice Address - Street 2:SUITE 280
Practice Address - City:COLUMBIA
Practice Address - State:MO
Practice Address - Zip Code:65203-2522
Practice Address - Country:US
Practice Address - Phone:573-875-0555
Practice Address - Fax:573-875-1062
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-27
Last Update Date:2009-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO639-8251E00000X
332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO580562809Medicaid
MO263535304Medicaid
60-00027OtherUNITED HEALTH CARE
30088OtherBC/BS OF MO
MO940562804Medicaid
18735OtherHEALTHCARE USA
MO820562809Medicaid
110232OtherHEALTH LINK
149839OtherBC/BS OF MO - HOSPICE
MO=========OtherCIGNA
MO=========OtherGROUP HEALTH PLAN
18735OtherHEALTHCARE USA
30088OtherBC/BS OF MO
MO=========OtherHUMANA
MO580562809Medicaid