Provider Demographics
NPI:1346319548
Name:NORTHEAST MISSOURI ASSOCIATES, INC.
Entity Type:Organization
Organization Name:NORTHEAST MISSOURI ASSOCIATES, INC.
Other - Org Name:LANCASTER CLINIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:EARL
Authorized Official - Last Name:MINTER
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:660-457-3772
Mailing Address - Street 1:PO BOX 295
Mailing Address - Street 2:
Mailing Address - City:LANCASTER
Mailing Address - State:MO
Mailing Address - Zip Code:63548-0295
Mailing Address - Country:US
Mailing Address - Phone:660-457-3772
Mailing Address - Fax:660-045-7311
Practice Address - Street 1:HWY 136
Practice Address - Street 2:
Practice Address - City:LANCASTER
Practice Address - State:MO
Practice Address - Zip Code:63548
Practice Address - Country:US
Practice Address - Phone:660-457-3772
Practice Address - Fax:660-457-3110
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-06
Last Update Date:2010-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MOR4F20207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO598542801Medicaid
MOD41544Medicare UPIN
MO598542801Medicaid