Provider Demographics
NPI:1952167355
Name:SHOW ME STATE INFUSION CLINIC, LLC
Entity Type:Organization
Organization Name:SHOW ME STATE INFUSION CLINIC, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ROSS
Authorized Official - Middle Name:
Authorized Official - Last Name:VOGEL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:573-307-9070
Mailing Address - Street 1:1704 BROADWAY ST # UNITE104
Mailing Address - Street 2:
Mailing Address - City:CAPE GIRARDEAU
Mailing Address - State:MO
Mailing Address - Zip Code:63701-4580
Mailing Address - Country:US
Mailing Address - Phone:573-307-9070
Mailing Address - Fax:
Practice Address - Street 1:1704 BROADWAY ST # UNITE104
Practice Address - Street 2:
Practice Address - City:CAPE GIRARDEAU
Practice Address - State:MO
Practice Address - Zip Code:63701-4580
Practice Address - Country:US
Practice Address - Phone:573-307-9070
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-02-23
Last Update Date:2024-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QI0500XAmbulatory Health Care FacilitiesClinic/CenterInfusion Therapy