Provider Demographics
NPI:1326289869
Name:GREGORY W SENSENICH INC
Entity Type:Organization
Organization Name:GREGORY W SENSENICH INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN/CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:GREGORY
Authorized Official - Middle Name:W
Authorized Official - Last Name:SENSENICH
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:660-646-0000
Mailing Address - Street 1:861 FAIRWAY DRIVE
Mailing Address - Street 2:
Mailing Address - City:CHILLICOTHE
Mailing Address - State:MO
Mailing Address - Zip Code:64601
Mailing Address - Country:US
Mailing Address - Phone:660-646-0000
Mailing Address - Fax:660-646-5404
Practice Address - Street 1:861 FAIRWAY DR
Practice Address - Street 2:
Practice Address - City:CHILLICOTHE
Practice Address - State:MO
Practice Address - Zip Code:64601-3673
Practice Address - Country:US
Practice Address - Phone:660-646-0000
Practice Address - Fax:660-646-5404
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-03-12
Last Update Date:2024-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MOR8G84208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO242414720Medicaid
MO000001620Medicare PIN
MOD41465Medicare UPIN