Provider Demographics
NPI:1770773756
Name:AUDRAIN HEALTHCARE INC
Entity type:Organization
Organization Name:AUDRAIN HEALTHCARE INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:
Authorized Official - Last Name:NEUENDORF
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:573-582-8103
Mailing Address - Street 1:PO BOX 478
Mailing Address - Street 2:
Mailing Address - City:MEXICO
Mailing Address - State:MO
Mailing Address - Zip Code:65265-0010
Mailing Address - Country:US
Mailing Address - Phone:573-581-8127
Mailing Address - Fax:
Practice Address - Street 1:809 MEDICAL PARK DR
Practice Address - Street 2:SUITE 101
Practice Address - City:MEXICO
Practice Address - State:MO
Practice Address - Zip Code:65265-3753
Practice Address - Country:US
Practice Address - Phone:573-581-8590
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-07-26
Last Update Date:2007-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty