Provider Demographics
NPI:1871241729
Name:EMINEM HOLD CO INC
Entity Type:Organization
Organization Name:EMINEM HOLD CO INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINIC EXECUTIVE
Authorized Official - Prefix:
Authorized Official - First Name:DENISE
Authorized Official - Middle Name:
Authorized Official - Last Name:BURROUGHS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:618-694-0739
Mailing Address - Street 1:3117 LEXINGTON AVE STE 101
Mailing Address - Street 2:
Mailing Address - City:CAPE GIRARDEAU
Mailing Address - State:MO
Mailing Address - Zip Code:63701-2692
Mailing Address - Country:US
Mailing Address - Phone:573-803-0935
Mailing Address - Fax:855-847-0863
Practice Address - Street 1:3117 LEXINGTON AVE STE 101
Practice Address - Street 2:
Practice Address - City:CAPE GIRARDEAU
Practice Address - State:MO
Practice Address - Zip Code:63701-2692
Practice Address - Country:US
Practice Address - Phone:573-803-0935
Practice Address - Fax:855-847-0863
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-03-10
Last Update Date:2022-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2083P0901XAllopathic & Osteopathic PhysiciansPreventive MedicinePublic Health & General Preventive MedicineGroup - Single Specialty