Provider Demographics
NPI:1881836021
Name:EAST MISSOURI ACTION AGENCY, INC.
Entity Type:Organization
Organization Name:EAST MISSOURI ACTION AGENCY, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:FAMILY PLANNING DIRECTOR
Authorized Official - Prefix:MISS
Authorized Official - First Name:ANGEL
Authorized Official - Middle Name:G
Authorized Official - Last Name:PRATHER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:573-431-5191
Mailing Address - Street 1:PO BOX 308
Mailing Address - Street 2:403 PARKWAY DRIVE
Mailing Address - City:PARK HILLS
Mailing Address - State:MO
Mailing Address - Zip Code:63601-0308
Mailing Address - Country:US
Mailing Address - Phone:573-334-2516
Mailing Address - Fax:573-334-4416
Practice Address - Street 1:1111 LINDEN ST
Practice Address - Street 2:
Practice Address - City:CAPE GIRARDEAU
Practice Address - State:MO
Practice Address - Zip Code:63703-7708
Practice Address - Country:US
Practice Address - Phone:573-334-2516
Practice Address - Fax:573-334-4416
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-04-02
Last Update Date:2009-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2002005956364SW0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes364SW0102XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistWomen's HealthGroup - Single Specialty