Provider Demographics
NPI:1497938658
Name:ASHLAR PROFESSIONAL
Entity Type:Organization
Organization Name:ASHLAR PROFESSIONAL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:COO/DIRECTOR OF OPERATIONS
Authorized Official - Prefix:
Authorized Official - First Name:CYNTHIA
Authorized Official - Middle Name:M
Authorized Official - Last Name:LINVILLE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:573-785-8766
Mailing Address - Street 1:816 UNIVERSITY PARKWAY
Mailing Address - Street 2:
Mailing Address - City:NATCHITOCHES
Mailing Address - State:LA
Mailing Address - Zip Code:71457
Mailing Address - Country:US
Mailing Address - Phone:318-352-8075
Mailing Address - Fax:318-357-1535
Practice Address - Street 1:1908 GREENWOOD DR STE B
Practice Address - Street 2:
Practice Address - City:POPLAR BLUFF
Practice Address - State:MO
Practice Address - Zip Code:63901-2430
Practice Address - Country:US
Practice Address - Phone:573-785-8766
Practice Address - Fax:573-785-8769
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:ASHLAR PROFESSIONAL GROUP
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-12-11
Last Update Date:2011-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center