Provider Demographics
NPI:1437281656
Name:DELTA AREA ECONOMIC OPPORTUNITY CORPORATION
Entity Type:Organization
Organization Name:DELTA AREA ECONOMIC OPPORTUNITY CORPORATION
Other - Org Name:DAEOC FAMILY PLANNING
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CLINIC BILLING COORDINATOR
Authorized Official - Prefix:
Authorized Official - First Name:SYREETA
Authorized Official - Middle Name:
Authorized Official - Last Name:BARNES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:573-276-6090
Mailing Address - Street 1:1 TOWN SQ
Mailing Address - Street 2:
Mailing Address - City:MALDEN
Mailing Address - State:MO
Mailing Address - Zip Code:63863-2171
Mailing Address - Country:US
Mailing Address - Phone:573-276-6090
Mailing Address - Fax:573-276-6108
Practice Address - Street 1:1 TOWN SQ
Practice Address - Street 2:
Practice Address - City:MALDEN
Practice Address - State:MO
Practice Address - Zip Code:63863-2171
Practice Address - Country:US
Practice Address - Phone:573-276-6090
Practice Address - Fax:573-276-6108
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-12
Last Update Date:2008-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO520525908Medicaid