Provider Demographics
NPI:1740559590
Name:MISSOURI CONSUMER DIRECT, LLC
Entity Type:Organization
Organization Name:MISSOURI CONSUMER DIRECT, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VP
Authorized Official - Prefix:MR
Authorized Official - First Name:GREER
Authorized Official - Middle Name:
Authorized Official - Last Name:WOODY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:406-532-1900
Mailing Address - Street 1:1903 S RUSSELL ST
Mailing Address - Street 2:
Mailing Address - City:MISSOULA
Mailing Address - State:MT
Mailing Address - Zip Code:59801-6603
Mailing Address - Country:US
Mailing Address - Phone:406-532-1900
Mailing Address - Fax:406-532-1901
Practice Address - Street 1:1903 S RUSSELL ST
Practice Address - Street 2:
Practice Address - City:MISSOULA
Practice Address - State:MT
Practice Address - Zip Code:59801-6603
Practice Address - Country:US
Practice Address - Phone:406-532-1900
Practice Address - Fax:406-532-1901
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-12-23
Last Update Date:2011-12-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health