Provider Demographics
NPI:1386625911
Name:PERRYVILLE HEALTH CARE CORPORATION
Entity Type:Organization
Organization Name:PERRYVILLE HEALTH CARE CORPORATION
Other - Org Name:PRESCRIPTION PLUS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:PATRICK
Authorized Official - Middle Name:
Authorized Official - Last Name:CARRON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:573-547-4960
Mailing Address - Street 1:212 HOSPITAL LN
Mailing Address - Street 2:STE 102
Mailing Address - City:PERRYVILLE
Mailing Address - State:MO
Mailing Address - Zip Code:63775-4204
Mailing Address - Country:US
Mailing Address - Phone:573-547-4960
Mailing Address - Fax:573-547-6540
Practice Address - Street 1:212 HOSPITAL LN
Practice Address - Street 2:STE 102
Practice Address - City:PERRYVILLE
Practice Address - State:MO
Practice Address - Zip Code:63775-4204
Practice Address - Country:US
Practice Address - Phone:573-547-4960
Practice Address - Fax:573-547-6540
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-11-10
Last Update Date:2010-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
4416320001Medicare NSC