Provider Demographics
NPI:1477559326
Name:HOSPICE OF MISSOURI, INC.
Entity Type:Organization
Organization Name:HOSPICE OF MISSOURI, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/CEO
Authorized Official - Prefix:MS
Authorized Official - First Name:DAWN
Authorized Official - Middle Name:E
Authorized Official - Last Name:MULLINS
Authorized Official - Suffix:
Authorized Official - Credentials:RN, BSN
Authorized Official - Phone:314-815-3434
Mailing Address - Street 1:2191 LEMAY FERRY RD
Mailing Address - Street 2:SUITE 301
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63125-2408
Mailing Address - Country:US
Mailing Address - Phone:314-815-3000
Mailing Address - Fax:314-815-3207
Practice Address - Street 1:6420 S LINDBERGH BLVD
Practice Address - Street 2:STE 100
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63123-7806
Practice Address - Country:US
Practice Address - Phone:314-892-3000
Practice Address - Fax:314-892-3101
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-06-24
Last Update Date:2008-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO1321HO251G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251G00000XAgenciesHospice Care, Community Based
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO261597Medicare Oscar/Certification