Provider Demographics
NPI:1508835893
Name:BANYAN GROUP, INC.
Entity Type:Organization
Organization Name:BANYAN GROUP, INC.
Other - Org Name:HEADACHE CARE CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CLINIC ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:DEBRA
Authorized Official - Middle Name:JANE
Authorized Official - Last Name:ARNOLD
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:417-890-7888
Mailing Address - Street 1:3805 S KANSAS EXPY
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:MO
Mailing Address - Zip Code:65807-6988
Mailing Address - Country:US
Mailing Address - Phone:417-890-7888
Mailing Address - Fax:417-890-8827
Practice Address - Street 1:3805 S KANSAS EXPY
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:MO
Practice Address - Zip Code:65807-6988
Practice Address - Country:US
Practice Address - Phone:417-890-7888
Practice Address - Fax:417-890-8827
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-03-17
Last Update Date:2011-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM1300XAmbulatory Health Care FacilitiesClinic/CenterMulti-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO000014842Medicare ID - Type UnspecifiedGROUP NUMBER