Provider Demographics
NPI:1912916248
Name:AUDRAIN HEALTH CARE, INC.
Entity Type:Organization
Organization Name:AUDRAIN HEALTH CARE, INC.
Other - Org Name:CENTRALIA MEDICAL CLINIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT/CEO
Authorized Official - Prefix:
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:A
Authorized Official - Last Name:NEUENDORF
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:573-582-8108
Mailing Address - Street 1:110 W SNEED ST
Mailing Address - Street 2:
Mailing Address - City:CENTRALIA
Mailing Address - State:MO
Mailing Address - Zip Code:65240-1375
Mailing Address - Country:US
Mailing Address - Phone:573-682-1330
Mailing Address - Fax:573-682-1936
Practice Address - Street 1:110 W SNEED ST
Practice Address - Street 2:
Practice Address - City:CENTRALIA
Practice Address - State:MO
Practice Address - Zip Code:65240-1375
Practice Address - Country:US
Practice Address - Phone:573-682-1330
Practice Address - Fax:573-682-1936
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:AUDRAIN HEALTH CARE, INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-08-05
Last Update Date:2008-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO268561Medicare Oscar/Certification