Provider Demographics
NPI:1477548873
Name:MAXICARE INC
Entity type:Organization
Organization Name:MAXICARE INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:NANCY
Authorized Official - Middle Name:GALE
Authorized Official - Last Name:MILER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:816-632-6658
Mailing Address - Street 1:811 S WALNUT ST
Mailing Address - Street 2:
Mailing Address - City:CAMERON
Mailing Address - State:MO
Mailing Address - Zip Code:64429-2349
Mailing Address - Country:US
Mailing Address - Phone:816-632-6658
Mailing Address - Fax:816-632-1892
Practice Address - Street 1:811 S WALNUT ST
Practice Address - Street 2:
Practice Address - City:CAMERON
Practice Address - State:MO
Practice Address - Zip Code:64429-2349
Practice Address - Country:US
Practice Address - Phone:816-632-6658
Practice Address - Fax:816-632-1892
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-09-13
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO1290650001Medicare ID - Type Unspecified