Provider Demographics
NPI:1679761449
Name:AUDRAIN HEALTH CARE, INC.
Entity Type:Organization
Organization Name:AUDRAIN HEALTH CARE, INC.
Other - Org Name:MEXICO UROLOGY SERVICES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT/CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:DAVE
Authorized Official - Middle Name:
Authorized Official - Last Name:NEUENDORF
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:573-582-8108
Mailing Address - Street 1:201 E MONROE ST
Mailing Address - Street 2:
Mailing Address - City:MEXICO
Mailing Address - State:MO
Mailing Address - Zip Code:65265-2852
Mailing Address - Country:US
Mailing Address - Phone:573-581-7582
Mailing Address - Fax:573-581-7583
Practice Address - Street 1:201 E MONROE ST
Practice Address - Street 2:
Practice Address - City:MEXICO
Practice Address - State:MO
Practice Address - Zip Code:65265-2852
Practice Address - Country:US
Practice Address - Phone:573-581-7582
Practice Address - Fax:573-581-7583
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:AUDRAIN HEALTH CARE, INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-10-05
Last Update Date:2007-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO31266208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208800000XAllopathic & Osteopathic PhysiciansUrologyGroup - Single Specialty