Provider Demographics
NPI:1700967429
Name:ANTHONY ZOFFUTO
Entity Type:Organization
Organization Name:ANTHONY ZOFFUTO
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ACCOUNT MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:JULIE
Authorized Official - Middle Name:
Authorized Official - Last Name:WHITESIDES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:800-540-6575
Mailing Address - Street 1:PO BOX 1286
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:MO
Mailing Address - Zip Code:65205-1286
Mailing Address - Country:US
Mailing Address - Phone:800-540-6575
Mailing Address - Fax:573-499-9418
Practice Address - Street 1:211 SAINT FRANCIS DR
Practice Address - Street 2:
Practice Address - City:CAPE GIRARDEAU
Practice Address - State:MO
Practice Address - Zip Code:63703-5049
Practice Address - Country:US
Practice Address - Phone:573-331-5330
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-18
Last Update Date:2007-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MOR4523174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CK6400OtherRAILROAD MEDICARE
CK6400OtherRAILROAD MEDICARE