Provider Demographics
NPI:1982616710
Name:LONG TERM CARE ASSOCIATES INC
Entity Type:Organization
Organization Name:LONG TERM CARE ASSOCIATES INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:H
Authorized Official - Last Name:NIELSON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:816-803-5173
Mailing Address - Street 1:PO BOX 752
Mailing Address - Street 2:
Mailing Address - City:CONCORDIA
Mailing Address - State:MO
Mailing Address - Zip Code:64020-0752
Mailing Address - Country:US
Mailing Address - Phone:660-463-1365
Mailing Address - Fax:660-463-1367
Practice Address - Street 1:3619 S DELAWARE AVE
Practice Address - Street 2:
Practice Address - City:INDEPENDENCE
Practice Address - State:MO
Practice Address - Zip Code:64055-3188
Practice Address - Country:US
Practice Address - Phone:816-803-5173
Practice Address - Fax:816-461-2367
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-12
Last Update Date:2012-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207QG0300XAllopathic & Osteopathic PhysiciansFamily MedicineGeriatric MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO505740902Medicaid
MOCJ5372Medicare Oscar/Certification
MO505740902Medicaid
KSCK7248Medicare Oscar/Certification
MOCJ5371Medicare Oscar/Certification
MOCJ5370Medicare Oscar/Certification
MOL690000AMedicare ID - Type Unspecified
MO000013562Medicare ID - Type Unspecified