Provider Demographics
NPI:1336389865
Name:CAH ACQUISITION COMPANY 6 LLC
Entity Type:Organization
Organization Name:CAH ACQUISITION COMPANY 6 LLC
Other - Org Name:I-70 MEDICAL CLINIC-CONCORDIA
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MRS
Authorized Official - First Name:JULIE
Authorized Official - Middle Name:A
Authorized Official - Last Name:DAVENPORT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:660-335-4700
Mailing Address - Street 1:607 S MAIN STREET
Mailing Address - Street 2:SUITE B
Mailing Address - City:CONCORDIA
Mailing Address - State:MO
Mailing Address - Zip Code:64021
Mailing Address - Country:US
Mailing Address - Phone:660-463-1010
Mailing Address - Fax:660-463-1070
Practice Address - Street 1:607 S MAIN STREET
Practice Address - Street 2:SUITE B
Practice Address - City:CONCORDIA
Practice Address - State:MO
Practice Address - Zip Code:64021
Practice Address - Country:US
Practice Address - Phone:660-463-1010
Practice Address - Fax:660-463-1070
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-02-24
Last Update Date:2010-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO261QP2300X
261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
MOT920000Medicare Oscar/Certification