Provider Demographics
NPI:1578978755
Name:ONCARE
Entity Type:Organization
Organization Name:ONCARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:KEVIN
Authorized Official - Middle Name:W
Authorized Official - Last Name:LOUDERBACK
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD HHP MHT PHD
Authorized Official - Phone:417-553-9583
Mailing Address - Street 1:918 SUNSHINE DR
Mailing Address - Street 2:
Mailing Address - City:MOUNT VERNON
Mailing Address - State:MO
Mailing Address - Zip Code:65712-1735
Mailing Address - Country:US
Mailing Address - Phone:417-553-9583
Mailing Address - Fax:417-553-9585
Practice Address - Street 1:918 SUNSHINE DR
Practice Address - Street 2:
Practice Address - City:MOUNT VERNON
Practice Address - State:MO
Practice Address - Zip Code:65712-1735
Practice Address - Country:US
Practice Address - Phone:417-553-9583
Practice Address - Fax:417-553-9585
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-06-25
Last Update Date:2015-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty