Provider Demographics
NPI:1396175188
Name:TRADEWINDS PALLIATIVE CARE LLC.
Entity type:Organization
Organization Name:TRADEWINDS PALLIATIVE CARE LLC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CEO/PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:PHILLIP
Authorized Official - Middle Name:M
Authorized Official - Last Name:BEYER
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:573-783-7625
Mailing Address - Street 1:101 KINGSBURY BLVD
Mailing Address - Street 2:
Mailing Address - City:FREDERICKTOWN
Mailing Address - State:MO
Mailing Address - Zip Code:63645-7959
Mailing Address - Country:US
Mailing Address - Phone:573-783-7625
Mailing Address - Fax:573-783-2126
Practice Address - Street 1:101 KINGSBURY BLVD
Practice Address - Street 2:
Practice Address - City:FREDERICKTOWN
Practice Address - State:MO
Practice Address - Zip Code:63645-7959
Practice Address - Country:US
Practice Address - Phone:573-783-7625
Practice Address - Fax:573-783-2126
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:SAFE HARBOR HOSPICES, INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2013-11-15
Last Update Date:2013-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Multi-Specialty