Provider Demographics
NPI:1528211182
Name:EAST MISSOURI ACTION AGENCY, INC.
Entity Type:Organization
Organization Name:EAST MISSOURI ACTION AGENCY, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:WOMEN'S WELLNESS CENTER DIRECTOR
Authorized Official - Prefix:MISS
Authorized Official - First Name:ANGEL
Authorized Official - Middle Name:G
Authorized Official - Last Name:PRATHER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:573-431-5191
Mailing Address - Street 1:P O BOX N
Mailing Address - Street 2:403 PARKWAY DRIVE
Mailing Address - City:PARK HILLS
Mailing Address - State:MO
Mailing Address - Zip Code:63601
Mailing Address - Country:US
Mailing Address - Phone:573-431-5191
Mailing Address - Fax:573-431-7449
Practice Address - Street 1:403 PARKWAY DRIVE
Practice Address - Street 2:
Practice Address - City:PARK HILLS
Practice Address - State:MO
Practice Address - Zip Code:63601
Practice Address - Country:US
Practice Address - Phone:573-431-5191
Practice Address - Fax:573-431-7449
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-10-28
Last Update Date:2008-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QF0050XAmbulatory Health Care FacilitiesClinic/CenterFamily Planning, Non-Surgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO520526005Medicaid