Provider Demographics
NPI:1649380122
Name:PROSPECTIVE HEALTHCARE CONSULTANTS
Entity Type:Organization
Organization Name:PROSPECTIVE HEALTHCARE CONSULTANTS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/SENIOR CONSULTANT
Authorized Official - Prefix:
Authorized Official - First Name:SHARON
Authorized Official - Middle Name:
Authorized Official - Last Name:WOOTEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:636-724-7539
Mailing Address - Street 1:930 1ST CAPITOL DR
Mailing Address - Street 2:
Mailing Address - City:SAINT CHARLES
Mailing Address - State:MO
Mailing Address - Zip Code:63301-2734
Mailing Address - Country:US
Mailing Address - Phone:636-724-7539
Mailing Address - Fax:636-724-7516
Practice Address - Street 1:930 1ST CAPITOL DR
Practice Address - Street 2:
Practice Address - City:SAINT CHARLES
Practice Address - State:MO
Practice Address - Zip Code:63301-2734
Practice Address - Country:US
Practice Address - Phone:636-724-7539
Practice Address - Fax:636-724-7516
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-30
Last Update Date:2007-11-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2083P0901XAllopathic & Osteopathic PhysiciansPreventive MedicinePublic Health & General Preventive MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO1245247881OtherINDIVIDUAL NPI