Provider Demographics
NPI:1326694605
Name:AFFIRM MANAGEMENT AND CONSULTING, LLC
Entity Type:Organization
Organization Name:AFFIRM MANAGEMENT AND CONSULTING, LLC
Other - Org Name:AFFIRM HEALTH CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:TRACIE
Authorized Official - Middle Name:LR
Authorized Official - Last Name:OJAKANGAS
Authorized Official - Suffix:
Authorized Official - Credentials:NP-C
Authorized Official - Phone:417-823-3901
Mailing Address - Street 1:4728 S CAMPBELL AVE STE 128
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:MO
Mailing Address - Zip Code:65810-1715
Mailing Address - Country:US
Mailing Address - Phone:417-823-3901
Mailing Address - Fax:417-823-3781
Practice Address - Street 1:4728 S CAMPBELL AVE STE 128
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:MO
Practice Address - Zip Code:65810-1715
Practice Address - Country:US
Practice Address - Phone:417-823-3901
Practice Address - Fax:417-823-3781
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-08-13
Last Update Date:2019-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Multi-Specialty
No363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary CareGroup - Multi-Specialty