Provider Demographics
NPI:1124456611
Name:PLATINUM HOMECARE
Entity type:Organization
Organization Name:PLATINUM HOMECARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:JERRY
Authorized Official - Middle Name:
Authorized Official - Last Name:BRUGGEMAN
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:573-303-3880
Mailing Address - Street 1:910 N COLLEGE AVE
Mailing Address - Street 2:SUITE 3
Mailing Address - City:COLUMBIA
Mailing Address - State:MO
Mailing Address - Zip Code:65201-4797
Mailing Address - Country:US
Mailing Address - Phone:573-303-3880
Mailing Address - Fax:888-339-4580
Practice Address - Street 1:910 N COLLEGE AVE
Practice Address - Street 2:SUITE 3
Practice Address - City:COLUMBIA
Practice Address - State:MO
Practice Address - Zip Code:65201-4797
Practice Address - Country:US
Practice Address - Phone:573-303-3880
Practice Address - Fax:888-339-4580
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-10-22
Last Update Date:2013-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health