Provider Demographics
NPI:1689831505
Name:CLEARWATER HEALTH RESOURCES INC
Entity Type:Organization
Organization Name:CLEARWATER HEALTH RESOURCES INC
Other - Org Name:MEDICAL CENTER PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JULIA
Authorized Official - Middle Name:
Authorized Official - Last Name:GRONSKI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:573-223-4235
Mailing Address - Street 1:PO BOX 278
Mailing Address - Street 2:
Mailing Address - City:PIEDMONT
Mailing Address - State:MO
Mailing Address - Zip Code:63957-0278
Mailing Address - Country:US
Mailing Address - Phone:573-223-4235
Mailing Address - Fax:573-223-4184
Practice Address - Street 1:RR 4 BOX 4515
Practice Address - Street 2:
Practice Address - City:PIEDMONT
Practice Address - State:MO
Practice Address - Zip Code:63957-9417
Practice Address - Country:US
Practice Address - Phone:573-223-4235
Practice Address - Fax:573-223-4184
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-05-19
Last Update Date:2009-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO620118604Medicaid
1276250001Medicare NSC