Provider Demographics
NPI:1124136890
Name:VAHL, RONALD A (CPO)
Entity type:Individual
Prefix:MR
First Name:RONALD
Middle Name:A
Last Name:VAHL
Suffix:
Gender:M
Credentials:CPO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2021 S WAVERLY AVE STE 300
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:MO
Mailing Address - Zip Code:65804-2417
Mailing Address - Country:US
Mailing Address - Phone:417-886-8881
Mailing Address - Fax:
Practice Address - Street 1:2021 S WAVERLY AVE STE 300
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:MO
Practice Address - Zip Code:65804-2417
Practice Address - Country:US
Practice Address - Phone:417-886-8881
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-25
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO026741744P3200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1744P3200XOther Service ProvidersSpecialistProsthetics Case Management
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO31440OtherBLUECROSS BLUESHIELD
MO0996130002Medicare ID - Type UnspecifiedWEST PLAINS
MO0996130001Medicare ID - Type UnspecifiedSPRINGFIELD