Provider Demographics
NPI:1619410198
Name:IHC OF MID MISSOURI, LLC
Entity Type:Organization
Organization Name:IHC OF MID MISSOURI, LLC
Other - Org Name:INTERIM HEALTHCARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR OF OPERATIONS
Authorized Official - Prefix:
Authorized Official - First Name:GARY
Authorized Official - Middle Name:
Authorized Official - Last Name:BODONY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:573-458-5990
Mailing Address - Street 1:13725 METCALF AVE
Mailing Address - Street 2:SUITE 411
Mailing Address - City:OVERLAND PARK
Mailing Address - State:KS
Mailing Address - Zip Code:66223-7899
Mailing Address - Country:US
Mailing Address - Phone:210-213-0248
Mailing Address - Fax:
Practice Address - Street 1:303 N STADIUM BLVD
Practice Address - Street 2:2ND FLOOR
Practice Address - City:COLUMBIA
Practice Address - State:MO
Practice Address - Zip Code:65203-1493
Practice Address - Country:US
Practice Address - Phone:573-458-5330
Practice Address - Fax:877-240-6523
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-12-01
Last Update Date:2016-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health